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
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
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
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
5
Q
interdisciplinary care plans
A
includes contributions from all disciplines involved in pt care
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
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
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
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
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.
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
12
Q
discuss the value of Nursing Intervention Classification (NIC) system in documenting nursing care
A
- 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
13
Q
NIC
A
Nursing Intervention Classification
14
Q
Discuss the steps for revising a plan of care before preforming implementation (258)
A
- revise data in assessment column to reflect pt’s current status, date any new data
- Revise the nursing diagnoses. Delete diagnoses that aren’t relevant, add and date any new ones
- Revise specific interventions that correspond to the new nursing diagnoses and goals. Revisions need to reflect pt’s current status
- choose method of eval to determine in you achieved pt outcomes
15
Q
define the three implementation skills
A
- 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
- interpersonal skills- develop a trusting relationship, express a level of caring, communicate clearly, be perceptive of verbal and nonverbal communication
- psychomotor skills- actual hands on care, performing skills correctly, smoothly, and confidently, integration of cognitive and motor activities
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
17
Q
direct care interventions
A
treatments that are performed through interactions w/ pts
ex. placing an IV, medication administration
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
19
Q
select the appropriate interventions for the assigned pt
A
c
20
Q
nursing process
A
Assessment Diagnosis Planning Implementation Evaluation (reassess)
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
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
23
Q
ANA
A
American Nurses Association
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.
25
activities of daily living (ADLs)
activities usually performed throughout a normal day (eg. walking, eating, dressing, bathing, and grooming)
26
nurse initiated interventions
are determined by state Nurse Practice Acts
27
Instrumental Activities of Daily Living (IADLs)
skills such as shopping, preparing meals, house cleaning, paying bills, taking meds
OTs work w/ pts to adapt to perform IADLs
28
lifesaving measure
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
29
counseling
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
30
adverse rxn
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
31
preventive nursing actions
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
32
patient adherence
means that pts and families invest time in carrying out required treatments
33
discuss the relationship between critical thinking and evaluation
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?
34
describe the standards of professional nursing practice for evaluation (p 267)
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
35
explain the relationship among goals of care, expected outcomes, and evaluative measures when evaluating nursing care
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
36
give examples of evaluation measures for determining a pt's progress towards outcomes
observations, vital signs, pt interview, mobility
37
evaluate the outcomes of care for a patient
evaluation is continuous and should be based on the pt's care plan
38
describe how evaluation leads to discontinuation, revision, or modification of a plan on care
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
39
evaluation
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
40
evaluative measure
assessment skills and techniques (e.g. observations, physiological measurements, pt interview)
41
nursing-sensitive outcome
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
42
standard of care
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
43
criterion-based standards
standards for evaluation are the physiological, emotional, and behavioral responses that are a pt's goals and expected outcomes
44
goal
expected behavior or response that indicates resolution of a nursing diagnosis or maintenance of a healthy state
45
expected outcome
end result that is measurable, desirable, and observable, and translates into observable pt behaviors
46
NOC
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
47
interpreting evaluation findings
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
48
two factors examined by evaluation
the appropriateness of the interventions selected and the correct application of the of the intervention
49
PES
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
50
MSU Denver
Metro State College- 1965, renamed MSCD in 1990, MSUD- July 1, 2012
51
MSUD Nursing
| History
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
52
MSUD Nursing Accreditation
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
53
Dept of Nursing- Mission
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.
54
Dept- Philosophy of Nursing Education
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
55
Dept- Philosophy of Nursing Education
| foundational documents for curriculum development
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)
56
Dept- Philosophy of Nursing Education
| Patient
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
57
Dept- Philosophy of Nursing Education
| Nursing
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
58
Dept- Philosophy of Nursing Education
| Health
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.
59
Dept- Philosophy of Nursing Education
| Environment
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.
60
Dept- Educational Philosophy
focused on learner-centered educational experiences, incorporate Principles of Adult Learning Theory, students valued for prior life and learning experiences
61
Baccalaureate Generalist Graduate
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.
62
Curriculum Framework
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
63
Curriculum Framework
| Communication
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
64
Curriculum Framework
| Critical Thinking and Clinical Reasoning
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
65
Curriculum Framework
| Patient Safety
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
66
Curriculum Framework
| Leadership & Management
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
67
Curriculum Framework
| Professionalism and Professional Values
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
68
Mid-Program Outcomes
| Communication
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).
69
Mid-Program Outcomes
| Critical Thinking and clinical reasoning
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.
70
Mid-Program Outcomes
| Leadership and Management
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)
71
Mid-Program Outcomes
| Patient Safety
Integrate the QSEN competencies into the delivery of nursing care.
Evaluate the effectiveness of processes related to maintaining patient safety in the clinical setting.
72
Mid-Program Outcomes
| Professionalism and Professional Values
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.
73
Quality and Safety Education for Nurses (QSEN) competencies
patient centered care, team work & collaboration, EBP, quality improvements, informatics, and safety
74
ANA
American Nurses Association
75
Florence Nightingale
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
76
Clara Barton
founder of American Red Cross, ARC ratified by Congress in 1882 after 10yrs of lobbying by CB, tended wounded soldiers in Civil War
77
Dorothea Lynde Dix
superintendent of the female nurses of the Union Army
| organized hospitals, appointed nurses, oversaw and regulated supplies to troops
78
Mother Bickerdyke
organized ambulance service, and walked abandoned battlefields at night looking for wounded soldiers
79
Harriet Tubman
active in the Underground Railroad movement, helping 300+ to freedom
80
Mary Mahoney
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
81
Isabel Hampton Robb
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
82
Mary Adelaide Nutting
helped move nursing education into universities
| 1906- 1st professor of nursing at Columbia University Teachers College
83
Army Nurse corps
established 1901
84
Navy Nurse corps
established 1908
85
Mary Adelaide Nutting, Lillian Ward, Annie Goodrich
Goldmark Report- concluded that nursing education needed increased financial support and suggested that university schools of nursing received $, 1920, pub. 1923
86
specialty areas of nursing
emerged in 1920s, organizations began in 940s and 1950s
87
Societal Influences are Nursing
| Demographics
: 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)
88
Societal Influences are Nursing
| Women's Health
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.
89
Societal Influences are Nursing
| Human Rights
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.
90
Societal Influences are Nursing
| medically underserved
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
91
Societal Influences are Nursing
| threat of bioterrism
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
92
influences of nursing today
rising cost of health care, EBP, nursing and biomedical research, nursing shortages, demographics
93
code of ethics
the philosophical ideals of right and wrong that define the principles you will use to provide care for you pts
94
Standards of Practice
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
95
Standards of Professional Performance
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
96
registered nurse (RN)
```
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
masters degree education
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)
98
doctoral preparation
: a DSN or DSC prepares you to apply research findings to clinical nursing. A PhD emphasizes basic research and theory .
99
continuing education
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
100
in-service education programs
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
101
Nurse Practice Acts
overseen by the State Boards of Nursing, regulate the scope of nursing practice and protect the public health, safety, and welfare
102
nurse licensure
RN candidates must past the NCLEX-RN which is administered by individual State Boards of Nursing
provides a standardized minimum knowledge base for nurses
103
nurse certification
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
104
professional responsibilities & roles of a nurse
autonomy and accountability, caregiver, advocate, educator, communicator, manager, career development
105
professional responsibilities & roles of a nurse
| autonomy and accountability
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
106
professional responsibilities & roles of a nurse
| caregiver
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
professional responsibilities & roles of a nurse
| advocate
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
professional responsibilities & roles of a nurse
| educator
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
professional responsibilities & roles of a nurse
| communicator
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
professional responsibilities & roles of a nurse
| manager
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
professional responsibilities & roles of a nurse
| types of careers
- 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
Clinical Nurse Specialist
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
Nurse Practitioner
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
Certified Nurse Midwife
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
Certified Registered Nurse Anesthetist
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
Nurse Educator
- 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
Nurse Administrator
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
Nurse Researcher
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
profesional Organization
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
NLN
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
ICN
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
ANA
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
patient-centered care
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
teamwork and collaboration
fxn effectively w/i nursing and interprofessional teams, fostering open communications, mutual respect, and shared decision making to achieve quality pt care
125
evidence-based practice
integrate best current evidence w. clinical expertise and pt/family preferences and values for delivery of optimal health care
126
quality improvement
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
safety
minimize the risk of harm to pts & providers through both system effectiveness & individual performance
128
informatics
use information and technology to communicate, manage knowledge, mitigate error, and support decision-making
129
QSEN
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
Genomics
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
Societal Influences are Nursing
| health care reform
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
Societal Influences are Nursing
| rising cost of health care.
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
PICOT
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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
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134
evidence-based practice (EBP)
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
discuss benefits of EBP
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
5 steps of EBP
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
problem-focused trigger
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
knowledge-focused trigger
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
PICOT example 1
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
PICOT example 2
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
peer-reviewed article
has been reviewed by a panel of experts familiar w/ the topic or subject matter of the article
142
levels of evidence available in the literature
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
elements of an EBP article
abstract, introduction, literature review or background, manuscript narrative, methods or design, results or conclusion, clinical implications
144
elements of an EBP article
| abstract
brief summary that quickly tells you if it's research or clinical based, summarizes the purpose, includes major themes or findings, and implications
145
elements of an EBP article
| introduction
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
elements of an EBP article
| literature review or background
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
elements of an EBP article
| manuscript narrative
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
elements of an EBP article
| methods or design
explain how research study was organized and conducted to answer research question or test the hypothesis (e.g. RCT, case control study, qualitative)
149
elements of an EBP article
| results or conclusions
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
elements of an EBP article
| clinical implications
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
hypotheses
predictions made about the relationship or differences between study variables
152
variables
concepts, characteristics, or traits that vary within or among subjects
153
meta-analyses or systematic review
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
discuss ways to apply evidence in practice
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
Steps of the Research Process
problem identification, study design, conducting the study, data analysis, use the findings
156
Steps of the Research Process
| Problem Identification
```
Identify are of interest of clinical problem
review the literature
formulate theoretical framework
identify study variables
devise research question(s)/hypotheses
```
157
Steps of the Research Process
| Study Design
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
Steps of the Research Process
| Conducting the study
```
obtain necessary approvals
recruit subjects
implement the study protocol/collect data:
pilot study may be done initially
continually assess study methodology,
```
159
Steps of the Research Process
| Data Analysis
Analyze the results of the study:
interpret demographics of study pop.
analyze each research question/hypothesis
interpret results, including conclusions & limitations
160
Steps of the Research Process
| use the findings
- formulate recommendations for further research
- determine implications for nursing
- disseminate the findings: presentations, publications, research use in practice
161
Nursing Research
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
example of nursing sensitive outcomes
-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
historical research
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
exploratory research
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
evaluation research
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
descriptive research
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
experimental research
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
correlational research
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
quality improvement (QI)
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
performance improvement (PI)
when an organization analyzes & evaluates current performance & uses the results to develop focused improvement actions
171
PDSA
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
relationship between EBP & QI
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
relationship between EBP & QI
| EBP
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
relationship between EBP & QI
| QI
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
critical thinking
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
evidenced-based knowledge
knowledge based on research or clinical expertise
177
critical thinking skills (p 193)
interpretation, analysis, inference, evaluation, explanation, self-regulations
178
characteristics of a critical thinker
- considers what is important in each situation
- observes and examines info
- imagines & explores alternatives
- makes informed decisions
179
concepts for a critical thinker (p 194)
truth seeking, open-midedness, analyticity, systematicity, self-confidence, inquisitiveness, maturity
180
critical thinking competencies (p195)
scientific method, problem solving, decision making, diagnostic reasoning and inference, clinical decision making
181
problem solving
involves evaluating the solution over time to make sure it is effective and trying different options if the problem reoccurs
182
decision making
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
diagnostic reasoning
analytical process for determining a pt's health problems
184
inference
process of drawing conclusions from related pieces of evidence & previous experience w/ evidence
185
clinical decision making
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
What is the purpose of the nursing process?
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
discuss clinical experience and critical thinking
- 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
components of critical thinking in nursing
| p 199
```
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
discuss how professional standards influence nurse's clinical decisions
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
reflection
the process of purposefully thinking back or recalling a situation to discover its purpose or meaning
191
discuss how reflection improves clinical decision making
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
discuss relationship of critical thinking and nursing assessment
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
two steps of nursing assessment
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
database
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
Data Collection
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
two approaches to comprehensive assessment
11 functional health patterns or problem-oriented approach
197
health perception-health management pattern
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
nutritional-metabolic pattern
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
elimination pattern
describes fxn of excretory fxn (bowel, bladder, and skin)
200
activity-exercise pattern
describes patterns of exercise, activity, leisure, and recreation; ability to perform ADLs
201
sleep-rest pattern
describes patterns of sleep, rest, and relaxation
202
cognitive-perceptual pattern
describes sensory-perceptual patterns; language adequacy, memory, decision-making ability
203
self-perception-self-concept pattern
describes pt's self-concpt pattern and perception of self (e.g. self-concept/worth, emotional patterns, body image)
204
role-relationship pattern
describes pt's patterns of role engagements and relationships
205
sexuality-reproductive pattern
describes pt's patterns of satisfaction and dissatisfaction w/ sexuality pattern; pt's reproductive patterns; premenopausal and postmenopausal problems
206
coping-stress tolerance pattern
describes pt's ability to manage stress; sources of support; effectiveness of the patterns in terms of stress tolerance
207
value-belief pattern
describe patterns of values, beliefs (including spiritual practices), and goals that guide pt's choices or decisions
208
problem oriented approach
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
subjective data vs objective data
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
sources of data
```
patient
family/significant other(s)
health care team
medial records
other records and scientific literature
nurse's experience
```
211
patient-centered interview
an approach for obtaining data that is needed to foster a caring nurse-pt role, adherence to interventions, & treatment effectiveness
212
steps to patient-centered interview
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
interview techniques
open-ended questions
back channeling
probing
close-ended questions
214
open-ended questions
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
back channeling
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
probing
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
closed-ended questions
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
concomitant symptoms
symptoms other than the primary symptom
| e.g. pain accompanied by nausea (nausea is concomitant)
219
nursing health history (p 214)
| a comprehensive health history covers all health dimensions
-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
Review of Systems (ROS)
a systematic approach for collecting a pt's self-reported data on all body systems
221
validation
comparison of data w/ another source to determine data accuracy
222
discuss relationship of interpretation & validation
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
discuss critical thinking and nursing diagnosis
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
medical diagnosis
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
nursing diagnosis
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
collaborative problem
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
data cluster
a set of signs or symptoms gathered during assessment that you group together in a logical way
228
defining characteristics
the clinical criteria that are observable & verifiable
229
clinical criterion
an objective or subjective sign, symptom, or risk factor that when analyzed w/ other criteria , leads to a diagnostic conclusion
230
related factor
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
3 types of nursing diagnoses
actual nursing diagnosis
risk nursing diagnosis
health promotion nursing diagnosis
232
actual nursing diagnosis
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
risk nursing diagnosis
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
health promotion nursing diagnosis
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
components of a nursing diagnosis
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
diagnostic label
- 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
etiology
(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
PES format
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
sources of diagnostic error
collecting, interpreting, clustering, labeling, documentation & informatics
240
sources of diagnostic error
| collecting
- lack of knowledge or skill
- inaccurate data
- missing data
- disorganization
241
sources of diagnostic error
| interpreting
- 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
sources of diagnostic error
| clustering
- insufficient cluster of cues
- premature or early closure
- incorrect clustering
243
sources of diagnostic error
| labeling
- 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
History of Nursing Diagnosis
- 1st introduced in 1950
- 1953, Fry proposed formulation of nursing diagnosis
- 1973, 1st national conference was held
- 1982. NANDA was founded
245
NANDA-I
North American Nursing Diagnosis Association-International
| -nursing diagnoses are listed according to NANDA-I
246
Diagnostic Statement Guidelines
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
nursing diagnosis- application to care planning
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
priority setting
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
priority setting- high priority
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
priority setting- intermediate priority
nursing diagnoses that involve non-emergent, nonlife-threatening needs of pts
251
priority setting- low priority
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
planning
involves setting priorities, identifying pt-centered goals & expected outcomes, & prescribing individualized nursing interventions
253
goal
is a broad statement that describes a desired change in a pt's condition or behavior
254
expected outcome
is a measurable criterion to evaluate goal achievement
| sometimes several outcomes must be met for a single goal
255
SMART goals
```
S- specific
M- measurable
A- attainable
R- realistic or reasonable
T- timely
```
256
patient-centered goal
a specific & measurable behavior or response that reflects a pt's highest possible level of wellness and independence in fxn
257
short-term goal
an objective behavior or response that you expect the pt to achieve in a short period of time (hrs to week)
258
long-term goal
an objective behavior that you expect the pt to achieve over a longer period (days, wks, months)
259
nursing sensitive pt outcome
is a measurable pt, family, or community state, behavior, or perception largely influenced by and sensitive to nursing interventions
260
Nursing Outcomes Classification (NOC)
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
6 important factors when choosing interventions
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
student care plans
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
scientific rationale
the reason that you chose a specific nursing action, based on supporting evidence
263
Critical thinking attitudes
eleven: confidence, thinking independently, fairness, responsibility and authority, risk taking, discipline, perseverance, creativity, curiosity, integrity, humility
