Flashcards in Unit Exam 2 Deck (89):
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
Five factors that may influence the communication process between nurse and client
Page 325 P+P 24-6
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
Nursing care in regard to clinical judgement and thinking is
Not linear, rather, holistic and continuous.
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.
Sit facing the patient
Observe open posture
Lean towards the patient
Eye contact if appropriate
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
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.
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
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)
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.
Forms of Quantitative 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.
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.
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
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.
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
Elements of a good article for evidence
Literature review or background
Manuscript narrative (purpose statement, methods or design, results and conclusions, clinical implications.)
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
Institutional review board
Part of the research process, all research programs must be reviewed by IRB
Constructs of spirituality
Helping patients maintain faithfulness to their belief system and worship practices.
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.
Leininger transcultural caring
Culturally congruent care.
Watson’s transpersonal caring
Healing and wholeness
Every persons care is important
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.
Standard of safety
Implies that organizations should not have different, lower standards of care on nights or weekends or during times of organizational change.
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.
Errors of commission
Doing the incorrect thing
Errors of omission
Not doing the right/correct thing, forgetting to do it.
Errors of execution
Doing the right thing the wrong way
QSEN safety definition
Minimizing the risk of harm to patient or provider through both system effectiveness and individual performance.
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.
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.)
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.
Four types of 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.
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.
Failure to provide prophylactic treatment and inadequate monitoring or follow- up of treatment
Lack of communication or lack of clarity in communication can lead to any of the 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.
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
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
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.
Seven concepts that contribute to culture of safety
1. Leadership 7. Patient centered care
3. An evidence base
6. Just culture
8 human factors that contribute to error
Disjointed supply sources
Missing or non-functioning supplies or equipment
Waiting for systems and processes
Difficulty accessing resources to continue care
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).
High reliability organizations:
Organizations in which the consequence of error is high but the occurrence of error is low
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
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.
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.
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.
Coordinated care as it relates to safety
Cross-disciplinary communications, scope of responsibility, and organizational support for speaking up when safety is compromised.
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.
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.
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
Physical assessment, occurs when interacting with patient, assessment of nonverbal expressions of emotion and mental status.
Using sense of touch to gather information in regards to skin and underlying tissues, bones, and muscle
Tapping the skin with fingertips to vibrate underlying tissues and organs
Listening to sounds the body makes in order to detect any variations from the normal
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
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
Three parts of a nursing diagnosis
Etiology (related factors
Symptoms (evidenced by)
The 5 levels of communication
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
Three primary categories of communication
Linguistic or verbal
Paralinguistic or nonverbal
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?
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
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.”
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.
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.
3 kinds of professional nursing relationships
Nurse-health care team
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
Identify self and patient
Situation at hand
Background of patient
Assessment and relevant information
Read back of orders once received
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?
Crew resource management
Decision making by generating alternative acceptable solutions
Appropriate workload distribution
Attributes of high reliability organizations
Sensitive to operations
Focused on prediction and prevention of errors
Reluctant to simplify
Reference to expertise
Nursing care delivery models (current)
Patient and family centered care
Total patient care
Patient centered care
Includes respect and dignity of the patient
Information sharing with the patient and family
Participation of the patient and family
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
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
Decisions are made at the staff level.
Clinical care coordination
Use of resources
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
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
Do the right things
Informs and prepare patient
Clean and organized work area
Keep patient needs at center of attention
Use of resources
Involve other members of the healthcare team
Ask more experienced nurses