fundamentals 14,15,16 Flashcards
(44 cards)
1
Q
THE NURSING PROCESS:OUTCOME IDENTIFICATION AND PLANNING:
GOAL OF OUTCOME IDENTIFICATION AND PLANNING STEP
A
- establish priorities
- identify and write expected patient outcomes
- select evidence based nursing interventions
- communicate the plan of care
- the goal has to be measerable
- should be in context of “patient demonstrated”
2
Q
OUTCOME IDENTIFICATION, PLANNING AND CRITICAL THINKING
A
- be farmilliar with standards and policies
- keeps goal patient centered
- keep the “big picture” in focus
- collaborate when needed
- does research support you plan?
- keep an open mind; recognize bias
3
Q
STANDARDS TO APPLY:
A
- the law
- national practice standards
- specialty professional organizations (orthopedic/ or nurse)
- the joint commission (accrediting body)
- the agency for health care research and quality (AHRQ)
- your employer (policies and procedures your employer may have)
4
Q
A
5
Q
COMPREHENSIVE PLANNING
A
INITIAL PLANNING:
- Developed by the nurse who performa the nursing history and physical assessment.
- adresses each problem listed in the prioritized nursing diagnoses
- identifies appropriate patient goals and related nursing care.
6
Q
COMPREHENSIVE PLANNING
ONGING PLANNING:
A
- carried out by the nurse who interacts with the patient
- keeps the plan up to date
- states nursing diagnoses more clearly
- develops new diagnoses
- makes outcomes more realistic and develops new outcomes as needed
- identifies nursing interventions to accomplish patient goals
7
Q
COMEPREHENSIVE PLANNING
DISCHARGE PLANNING:
A
- carried out by the nurse who worked most closely with the patient
- begins when the patient is admitted for treatment
- uses teaching and counseling skills effectivly to ensure home care behaviors are performed competently
8
Q
PRIORITIZING NURSING DIAGNOSES
A
- high priority-greatest threat to the patients weel being
- medium priority-non threatning diagnoses
- low priority-diagnoses not specifically related to current health problem (remember wording)
- based on airway,breathing,circulation
- maslows
9
Q
MASLOWS HIERARCHY
A
- PHYSIOLOGIC NEEDS
- SAFETY NEEDS
- LOVE AND BELONGING NEEDS
- SELF-ESTEEM NEEDS
- SELF-ACTUALIZATION
10
Q
IDENTIFYING AND WRITING OUTCOMES
A
- deriving outcomes from nursing diagnoses
- nursing outcomes classification (NOC)
11
Q
LONG TERM VS. SHORT TERM OUTCOMES
A
- LONG-TERM:requires a longer period to be achieved and may be used as discharge goals
- SHORT-TERM:may be accomplished in a specific period of time (specific time frame) sometimes is called “Expected outcomes”
12
Q
PATIENT-CENTERED OUTCOMES
A
- CONSIDER:
- type of health concern
- nursing and/or medical diagnoses
- patient characteristics (stage of development)
- patient recources
- patient prefrences
- patient capacities
- treatment potential
13
Q
QUALITY OUTCOMES: 6 AIMS
A
- (IOM) INSTITUTE OF MEDICINE
- safety-errors/injuries
- effectiveness
- patient centered
- timely
- efficient
- equitable
14
Q
CATAGORIES OF OUTCOMES
A
- COGNITIVE: describes increases in patient knowledge or intellectual behaviors
- PSYCHOMOTOR: describes patients achievement of new skills
- AFFECTIVE:describes changes in patient values, beliefs, and attitudes (values)
*should be able to decide which information goes into each catagory
15
Q
WRITING MEASURABLE OUTCOMES
A
INCLUDE:
- subject-patient
- verb-action
- conditions
- performance criteria-observable, measurable terms
- target time-realistic
16
Q
COMMON ERRORS IN WRITING OUTCOMES
A
- expressing patient outcomes as nursing intervention
- using verbs that are not observable or measurable (good, very)
- including more than one patient behavior or manifestation in short term outcomes\writing vague outcomes
17
Q
NURSING INTERVENTIONS TYPES:
A
- NURSE INITIATED-actions performed by a nurse without a physicians order.
- PHYSICIAN INITATED-actions initiated by a physcian in response to a medical diagnoses but carried out by a nurse under doctors orders.
- COLLABORATIVE:treatments initiated by other providers and carried out by a nurse.
18
Q
NURSE INITIATED INTERVENTIONS
A
- monitor health status
- reduce risks
- resolve,prevent. or manage a problem
- facilitate independence or assist with ADLS (improve independence).
- Promote optimum sense of physical psycholgical, and spiritual well-being.
19
Q
NURSING INTERVENTIONS
A
- nursing intervention classification system
- box14-4 guidelines for selecting nursing interventions
20
Q
TYPES OF INSITUTIONAL CARE PLANS
A
- kardex plans of care
- computerized plans of care
- case management plans of care
- clinical pathways, care maps (post op) day 1, day 2, day 3
- student plans of care (box 14-7)
- comcept map care plan
*be able to differenciate on test
21
Q
PROBLEMS RELATED TO OUTCOME ID AND PLANNING
A
- failure to involve the patient
- insufficient data collection
- nursing diagnoses developed from inacurrate or insufficient data
- outcomes stated to broadly
- outcomes derived frompoorly developed nursing diagnoses
- failure to write nursing order clearly
- Nursing orders that do not solve problems
- failure to update plan of care
22
Q
BENIFITS OF NOC/NIC
A
- demonstrate the impact that nurses have on the system of healthcare delivery
- define the knowledge base for nursing curricula and practice
- facilitate the selection of appropriate nursing intervention
- enable researchers to examine the effectiveness and cost of nursing care
- assisst educators to develop curricula that better articulates with clincal practice. facilitate the teaching of clinical decision making to novice nurses
- assist administers in planning more effectivly for staff and equipment needs.
- communicate the nature of nursing to the public
23
Q
THE NURSING PROCESS: IMPLEMENTING
CRITICAL THINKING AND IMPLEMENTING
A
- Patient conditions can change rapidly; nurse must continually reasses.
- reassessment may lead to changes in outcomes and interventions.
- research should support the interventions
- monitor response to interventions
- seek assisstance
24
Q
NURSING INTERVENTIONS
A
DIRECT CARE INTERVENTION:
- hands on
INDIRECT CARE INTERVENTION
- Care comfrence for the patient
COMMUNITY/PUBLIC HEALTH INTERVENTION
- Organizing immunization event
25
**TYPES OF NURSING INTERVENTIONS**
**INDEPENDENT NURSING ACTIONS:**
* Nurse initiated interventions
* protocols
* standing orders
26
**DEPENDENT NURSING ACTIONS**
* Psyscian-initiated interventions
* doctor orders taken by RN
27
**INDEPENDENT NURSING ACTIONS**
* Collaborative interventions
* jointly with other people
* carry out orders for PA,NP
28
**IMPLEMENTING THE PLAN OF CARE**
**ORGANIZATION:**
* **Patient and visitors:**
* okay to talk in front of family members/visitors? any distractions for patient? is there any education needed?
* **Equipment:**
* risk/have suction equipment for someone who may have problems swallowing
* **Enviroment:**
* Privacy/warmth
* **Personnel:**
* adaquate amount of people available for lifts.
29
**IMPLEMENTING THE PLAN OF CARE**
* Anticipate unexpected outcomes/situations
* Promote self care: teaching, counseling, and advocacy. Promoting independence
30
**VARIABLES THAT INFLUENCE THE OUTCOME**
* Developmental stage
* psychosocial backgroumd
* nurse
* recources
* current standard of care
* research findings
* ethical and legal guides
* avoid stereotypes
* are they able to pay for their prescription?
* new/expierienced nurse
31
**DOCUMENTATION**
**IT WASNT DONE IF IT WASNT DOCUMENTED!**
32
**PATIENT NONCOMPLIANCE**
* Lack of family support
* lack of understanding about the benifits
* low value attached to outcomes
* adverse physical or emotional effects of treatment
* inability to afford treatment
33
**DELEGATING NURSING CARE**
DELEGATION:
* transfer of responsibility for the performance of an activity to another person, while retaining accountability for the outcome of what is delegated
UNLICENSED ASSISTIVE PERSONNEL:
* Nurse "extenders" trained to function in an assistive role to the RN
34
**ESSENTIALS OF EFFECTIVE DELEGATION**
* know your state and instuitional policies on delegation
* be clear on the difference on nursing and nursing tasks
* know the training and background of the unlicensed assistive personnel
* know the patients needs
* **is it appropriate for CNA to still do specific task if patients condition changes.**
35
**CONT..**
* have the person repeat your instructions to be sure you have communicated them clearly
* make frequent walking roundsto asses patients
* take frequent mini reports for the UAP.
* evaluate the UAPs performance and the patients response.
36
37
**THE NURSING PROCESS: EVALUATING**
**ACTION BASED ON EVALUATION:**
* terminate plan of care when expected outcome is achieved
* modify plan of care if there are difficulties achieving outcome.
* comtinue plan of care if more time is needed for outcome.
* **EVALUATING OUTCOMES AND GOALS**
38
**5 CLASSIC ELEMENTS OF EVALUATION:**
* identifying evaluative criteria and standards (measurable)
* collecting data to determine if criteria and standards are met
* interpretating and summarizing findings
* document judgement
* terminating, continuing, or modifying the plan
39
**EVALUATIVE CRITERIA VS. STANDARDS**
* Criteria-measurable qualities, attributes, or characteristics that specify skills,knowledge, or health status.
* describe acceptable levels of performance by stating expected behaviors of nurse or patient
* Standards-levels of performance accepted and expected by the nursing staff.
* established by authority, custom, or consent.
* **evaluating outcomes and patient responses.**
* **Purpose: directs nursing interventions**
40
**4 TYPES OF OUTCOMES**
**COGNITIVE:**
* Increase in patient knowledge (describe, verbalize,plan)
**PSYCHOMOTOR:**
* patints achievement of new skills (Doing)
**AFFECTIVE:**
* Changes in patient values, beliefs and attitudes. (evaluate through observing/conversation)
**PHYSIOLOGIC:**
* physical changes in the patient (eatching patients condition, color, pain, redness)
41
**EVALUATING OUTCOMES**
**COGNITIVE:** asking the patient to repeat information or apply new knowlege
**PSYCHOMOTOR:** asking patient to demonstrate new skill
**AFFECTIVE:**observing patient behavior and conversation
**PSYIOLOGIC:** using physical assessment skill to collect and compare data.
42
**VARIABLES AFFECTING OUTCOME ACHIEVEMENT**
* PATIENT:
* For example, a patient gives up and refuses treatment. Apatient that is passive and tells you what you want to hear, never following through with the plan of action.
* NURSE:
* for example, a nurse is suffering from burn-out/inexpierenced.
* HEALTHCARE SYSTEM
* for example, inadequate staffing/poor moral/inadaquate staffing
43
**EVALUATIVE STATEMENTS**
* decide how well the outcome was met (met/partially met/not met)
* list patient data or behaviors that support this decision.
44
**REVISIONS IN THE PLAN OF CARE**
* delete or modify the nursing diagnoses
* document changes in patient chart
* make the outcome statement more realistic
* increase the complexity of the outcome statement
* adjust time criteria in outcome statement.
* change nursing interventions.
* pg 310 in fundaments book
