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Flashcards in Unit Exam 2 Deck (89):
1

The four phases of a nurse-patient relationship

Pre-interaction: Prior to meeting, review data, talk to caregivers, anticipate concerns

Orientation: meeting, superficial, health status review, prioritize problems and develop goals, establish termination.

Working: interventions, goals, interaction, care

Termination: evaluate, separate and relinquish responsibility

2

Five factors that may influence the communication process between nurse and client

Page 325 P+P 24-6
Psychophysiological
Relational
Situational
Environmental
Cultural

3

SBAR

Situation

Background

Assessment

Recommendation

4

Clinical Judgement

Clinical judgement is the interpretation or conclusion about a patients needs, concerns, or health problems, and the decision to take action, or not, use or modify standard approaches, or improvise new ones as deemed appropriate by the patients response

5

Nursing care in regard to clinical judgement and thinking is

Not linear, rather, holistic and continuous.

6

Motivational interviewing

A technique that encourages sharing of thoughts, beliefs, fears and concerns with the aim of behavioral change, the interview is delivered in a non-judge mental guided communication approach.

7

SOLER

Sit facing the patient
Observe open posture
Lean towards the patient
Eye contact if appropriate
Relax

8

Therapeutic communication techniques

Sharing observations. Providing relevant information
Sharing empathy Clarifying information
Sharing hope. Focusing
Sharing humor. Paraphrase
Sharing feelings. Validation
Using touch Asking relevant questions

9

Evidence-based practice (EBP)

A problem salving approach to clinical practice that integrates the conscientious use of best evidence in combination with the clinicians expertise and patient preferences and values in making decisions about patient care. Today, EPB is an expectation of all health care facilities and nurses.

10

The seven steps of EBP

0. Cultivate spirit of inquiry
1. Ask clinical question in PICOT format
2. Search for the best, most relevant evidence
3. Critically appraise evidence gathered
4. Integrate all evidence with your clinical expertise and patient preferences/values
5. Evaluate the outcomes of practice decisions or changes using evidence
6. Share the outcomes with others

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PICOT question format

P=Patient population of interest (identify by age, gender, disease, ethnicity).
I=Intervention of interest
C=Comparison of interest (what do we already do?)
O=Outcome (What result do you wish to achieve)
T= Time (What amount of time is needed for an intervention to achieve the outcome)

12

Quantitative research

The study of nursing phenomena that offers precise measurement and quantification. Ex (a study dealing with a new pain therapy quantitively measures participants pain severity) or (a study testing different forms of surgical dressings measures wound healing). his type of research is precise, systematic, objective examination of specific concepts focusing on numerical data, stats, and controls.

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Forms of Quantitative research

Experimental:
Nonexperimental:
Survey:
Evaluation:

14

Qualitative research

Research that is done on phenomena that are difficult to quantify or categorize such as a patients perception of illness or quality of life. This type of research involves inductive reasoning to develop generalizations of theories.

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Social determinants of Health

The conditions by which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels.

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Steps of evidence based practice

0. Cultivate a spirit of inquiry
1. Ask a clinical question in PICOT format
2. Search for best most relevant evidence
3. Critically appraise evidence gathered
4. Integrate all evidence with your clinical expertise and patient preferences and values
5. Evaluate outcomes of practice decisions changes using evidence.
6. Share outcomes

17

Define evidence based nursing

The conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences.

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Critical appraisal of evidence

After finding and critiquing all articles for a PICOT question
Synthesize or combine findings
Consider the scientific rigor of the evidence and whether it has application in practice

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Elements of a good article for evidence

Abstract
Introduction
Literature review or background
Manuscript narrative (purpose statement, methods or design, results and conclusions, clinical implications.)

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Outcomes Research

What is the benefits vs risks
What is the cost
Holistic effects of treatment
Outcomes must be observable or measurable
Helps patients, HCP, and those in health care policy make informed decisions on the basis of current evidence

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Institutional review board

Part of the research process, all research programs must be reviewed by IRB

22

Constructs of spirituality

Self-transcendence
Connectedness
Faith
Hope

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Religious care

Helping patients maintain faithfulness to their belief system and worship practices.

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Spiritual care

Helping people identify meaning and purpose in life, look beyond the present, and maintain personal relationships as well as a relationship with a higher being or life force.

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Leininger transcultural caring

Culturally congruent care.

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Watson’s transpersonal caring

Healing and wholeness
Every persons care is important

27

Institution of medicines definition of safety

Freedom from accidental injury. Establishing of operational systems and processes that minimize the likelihood of errors and maximizes the likelihood intercepting them when they do occur. Safe care is avoiding injuries to patients from the care that is intended to help them. Care that maintains a focus on using evidence in clinical decisions so to maximize health outcomes, while reducing the potential form harm.

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Standard of safety

Implies that organizations should not have different, lower standards of care on nights or weekends or during times of organizational change.

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National patient safety foundation definition of safety

Prevention of health care errors, and the elimination or mitigation of patient injury caused by those errors.

Any error is defined as unintended health care outcomes caused by a defect in the delivery of care to the patient.

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Errors of commission

Doing the incorrect thing

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Errors of omission

Not doing the right/correct thing, forgetting to do it.

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Errors of execution

Doing the right thing the wrong way

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QSEN safety definition

Minimizing the risk of harm to patient or provider through both system effectiveness and individual performance.

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Adverse event

An event that results in unintended harm to the patient by an act of commission or omission rather than by underlying disease or condition of the patient.

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Near miss

An error of commission (Care not provided correctly) or omission (did not provide care) that could have harmed the patient, but serious harm did not occur as a result of chance (patient receives contraindicated drug but does not experience any adverse effects), prevention (lethal dose was prescribed, but nurse caught the error), or mitigation, (overdose was recognized and taken care of early.)

36

Sentinel event

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or a risk thereof. Serious injury specifically includes loss of limb or function. These events signal the need for immediate investigation and response.

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Four types of errors

Diagnostic
Treatment
Preventive
Communication failure

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Diagnostic errors

Result of a delay in diagnosis, failure to employ indicated tests, use of outmoded tests, or failure to act on the results of screening or monitoring.

39

Treatment errors

The performance of an operation, procedure, or test, in administering a treatment, in the dose or method of administering a drug, or in avoidable delay in treatment or responding to an abnormal test.

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Preventive errors

Failure to provide prophylactic treatment and inadequate monitoring or follow- up of treatment

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Communication failure

Lack of communication or lack of clarity in communication can lead to any of the errors.

42

Active errors

Providers who are providing patient care at the “sharp end” which is the point of care. For example, a nurse administers the wrong medication because of failure to check the label is involved in an active error.

43

Latent errors

Organizational, contextual, and diffuse in nature or design-related, are errors occurring at the “blunt end.” Latent failure is a flaw in the system that does not immediately lead to accident but establishes a situation in which a triggering even may lead to an error. Latent errors can manifest as active. For example, an improperly stocked Pyxis causes the nurse to improperly admin. Meds. The latent error is the Pyxis stocking, active is the nurse admin. Meds

44

Culture of safety

The product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organizations health and safety management. Communication guided by mutual trust, shared perceptions of the importance of safety, and confidence that error-preventing strategies will work is paramount to positive safety culture

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Culture of safety, continued

When errors do occur, the focus is on what went wrong rather than who committed the error. This shifts the focus from identifying fault to establish blame and then determine discipline to acknowledging and reporting errors to improve the system.

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Seven concepts that contribute to culture of safety

1. Leadership 7. Patient centered care
2. Teamwork
3. An evidence base
4. Communication
5. Learning
6. Just culture

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8 human factors that contribute to error

Disjointed supply sources
Missing or non-functioning supplies or equipment
Repetitive travel
Interruptions
Waiting for systems and processes
Difficulty accessing resources to continue care
Communication breakdown
Communication media

48

Crew resource management

A set of instructional strategies designed to improve teamwork by applying well tested training tools (performance measures, exercises, and feedback mechanisms), and appropriate training methods, (simulations, lecture, videos), targeted at specific content, (teamwork, knowledge, skills, and attitudes).

49

High reliability organizations:

Organizations in which the consequence of error is high but the occurrence of error is low

50

The 5 attributes of High reliability organizations

Exhibit sensitivity to operations- situational awareness- process anomalies and outliers are quickly identified.
Focus on prediction of error-near misses are taken seriously
Reluctance to simplify- acceptance of inherent complexity of work.
The deference to expertise- defer to person with most knowledge and info of the current issue or concern. The deemphasis on hierarchy.
The ability to quickly contain errors and return to functioning despite them

51

Health care transparency

Making information about where and from whom they receive care, the safety of a system, evidence based practice, and patient satisfaction available to the patient. Additionally, open communication with the patient about their care, including adverse and sentinel events.

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Health care quality

Identifying the that occurs between ideal care and actual care delivered. Quality improvement is an approach to practice that measures the variance in ideal and actual care and implements strategies to close the gap.

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Communication as it relates to safety

Standardized communication can ensure safe handoffs between providers or between settings, provide clear direction in seeking and sharing information between providers, and instill collaborative behaviors for speaking up to prevent errors from occurrin.

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Coordinated care as it relates to safety

Cross-disciplinary communications, scope of responsibility, and organizational support for speaking up when safety is compromised.

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Collaboration as it relates to safety

Begins with self-development based on emotional intelligence to monitor appropriate reactions and responses to team members. Nurses need skills in problem solving, conflict resolution, and negotiation to be able to coordinate safe care across inter professional teams. Shared leadership based on the provider most expert in the situation is consistent with HROS.

56

Body alignment

The relationship of one body part to another along a horizontal or vertical line. Correct alignment involves postioning so that no excessive strain is placed on a persons joints, tendons, ligaments, or muscles. Alignment contributes to balance.

57

Body balance

A relatively low center of gravity is balanced over a wide, stable base of support and a vertical line false from the center of gravity through the base of support. To increase balance, nurses can widen the bas elf support by separating the feet, as well as bringing the center of gravity closer to the base of support, ex: raising the height of a hospital bed when performing a procedure to prevent bending too far at the waist

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Inspection

Physical assessment, occurs when interacting with patient, assessment of nonverbal expressions of emotion and mental status.

59

Palpation

Using sense of touch to gather information in regards to skin and underlying tissues, bones, and muscle

60

Percussion

Tapping the skin with fingertips to vibrate underlying tissues and organs

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Auscultation

Listening to sounds the body makes in order to detect any variations from the normal

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Concepts of a nursing history

Biographical information. Present illness or health concerns
Reason for seeking care. Family history
Past health history. Psychosocial history
Environmental history Systems review
Spiritual health Documentation
Expectations

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Focused assessment

A focused assessment is a group of manifestations that tell the nurse where to focus care - used to create diagnosis
Medical or surgical diagnosis
Complication of diagnosis
High risk treatment
System

64

Three parts of a nursing diagnosis

Problem (label)
Etiology (related factors
Symptoms (evidenced by)

65

The 5 levels of communication

Intrapersonal
Interpersonal
Small group
Public
Electronic

66

Circular transactional model of communication

Referent - motivates one person to communicate with another
Sender and receiver - senders message is a referent
Message - content of the communication
Channels - the means by which messages are sent
Feedback - sender receives from receiver
Interpersonal variables + environment - different interpretations/what effects communication

67

Three primary categories of communication

Linguistic or verbal
Paralinguistic or nonverbal
Meta communication

68

Verbal communication

Spoken or written words. Usage of vocabulary, denotative and connotative meaning, pacing, intonation, clarity, and timing/relevance all influence verbal communication. Connotation is how others interpret a word based on their ideas. Intonation is the WAY you say something. Timing is everything. Is now a good time?

69

Paralinguistic or nonverbal communication

Includes the five senses and everything that does not include words. “If looks could kill.” Voice tone, eye contact, body position. Nonverbal communication is often thought of as unconsciously motivated and more accurately represents a persons intended meaning. Appearance, posture/gait, facial expressions, eye contact, gestures, sounds, and personal space/territoriality are aspects of nonverbal messages

70

Meta communication

A board term referring to all factors that influence communication. Awareness of these factors helps reveal true messages. “ you say you’re fine but you look worried.”

71

Nurse patient relationship

Caring relationships are the foundation of clinical nursing practice, and therapeutic relationships promote psychological climate that facilitates positive change and growth. The nurse patient relationship has four phases: Preinteraction, orientation, working, termination.

72

Motivational interviewing

Technique that encourages patients to share their thoughts, beliefs, fear, and concerns with the aim of changing their behaviors, and is delivered in a nonjudgemental, guided communication approach.

73

3 kinds of professional nursing relationships

Nurse-family
Nurse-health care team
Nurse-community

74

Elements of professional communication

Appearance, demeanor, behavior
Courtesy- common courtesy, hello/goodbye introduce, say title
Use of names - give your name and title, address them by name
Autonomy - make choices and accept responsibility
Trustworthiness - communicate warmth and demonstrate consistency
Assertiveness - express feelings without judging or hurting others

75

ISBARR

Identify self and patient
Situation at hand
Background of patient
Assessment and relevant information
Recommendation
Read back of orders once received

76

SBAR

A technique that provides standardized framework for members of the health care team to communicate about a clients condition. Situation-what is happening with the client?
Background- clinical background?
Assessment - what is the problem?
Recommendation - what would i do?

77

Crew resource management

Focus on
Situational awareness
Problem identification
Decision making by generating alternative acceptable solutions
Appropriate workload distribution
Time management
Conflict resolution

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Attributes of high reliability organizations

Sensitive to operations
Focused on prediction and prevention of errors
Reluctant to simplify
Reference to expertise

79

Nursing care delivery models (current)

Patient and family centered care
Total patient care
Case management

80

Patient centered care

Includes respect and dignity of the patient
Information sharing with the patient and family
Participation of the patient and family
Collaboration

81

Total patient care

RNs work with patient, family, and health care team directly
The RN is responsible for patients during shift of care, although care can be delegated.
High number of RNs needed.
Patient satisfaction is high

82

Case management

Collaborative process of assessing, planning, facilitating, and advocating for patient options and services to meet their individual needs.
Clinicians oversee the management of patients with specific, complex health problems and are usually held accountable for some standard of cost management and quality.
Often case managers are APRN who helps improve patient outcomes via specific interventions

83

Decentralized management

Decisions are made at the staff level.
Encompasses:
Responsibility
Autonomy
Authority
Accountability

84

Clinical care coordination

Clinical decisions
Priority setting
Organizational skills
Use of resources
Time management
Evaluation

85

Clinical decisions

Are made by
Applying the nursing process
Knowing the patient and their medical history
Use of clinical decision making practices

Clinical decision making keeps you
Focused on the proper course of action

86

Priority setting

Determining which patient needs should be addressed first
High - threaten safety or survival
Intermediate - non emergent but needs relate to condition and well being
Low- I need a snack

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Organizational skills

Do the right things
Informs and prepare patient
Clean and organized work area
Keep patient needs at center of attention

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Use of resources

Involve other members of the healthcare team
Ask more experienced nurses

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Time management

Remains goal oriented
Identify priorities
Establish personal goals