FUNDAMENTALS OF NURSING

NR 226 Fundamentals of Nursing Exam 3 Chapter 21: Managing Care 1. Prioritizing patient care:  extremely important because it allows the nurse to see relationships among patient problems & avoid delays in taking action that can potentially prevent serious complications for a patient.  act immediately to stabilize conditions  remember ABC: airway, breathing, circulation as top priority High  Emergency; immediate threat to survival or safety  Example: obstructed airway, anxiety attack Intermediate  non-emergency, non life threatening actual or potential needs the patient & family members are experiencing  Example: anticipating teaching needs of patient related to a new drug, taking measures to decrease post-op pain Low  actual or potential problems that are not directly related to a patient's illness or disease (developmental or long-term health needs)  example: patient at admission that will need patient teaching prior to discharge 2. Types of Nursing: Primary Nursing  One RN assumes responsibility for the caseload  lateral communication from nurse to nurse  RNs have limited # of patients  RN assesses patients & develops care plans  variety of staffing levels & mixes  Cons: model does not always decrease costs, associate nurse cannot change care plan without approval Total Patient Care  RN in charge of all aspects of care  delegation allowed  RN works directly with patient & family, other healthcare team members  RN plans care  Cons: not cost effective due to high # of RNs needed, continuity of care a problem if communication lacks Functional Nursing   Case Management  coordinates & links health care services to patients & their families while streamlining costs & maintaining quality  collaborative process of assessment, planning, facilitation & advocacy  clinicians oversee management of patients with specific healthcare problems & are held accountable for costs management & quality  Cons: do not always provide direct care Team Nursing  RN leads team of other RNs, LPNs, and MA  Team provides direct patient care under RN supervision  Cons: TL takes time to delegate, RN does not spend time with patients FUNDAMENTALS OF NURSING  Leader develops care plans & provides complex nursing skills  Hierarchy in communication 3. Magnet Hospital  clinical promotion systems, research & evidence-based practice  nurses have professional autonomy over their practice; control over their practiceenvironment  empower nursing team to make changes & be innovative  strong collaborative relationship amongst team & improved patient quality of care 4. Delegation including to medical assist and LPN: as transferring responsibility for the performance of an activity or task while retaining accountability for the outcome.  Assess knowledge & skills, then match tasks  communicate clearly, listen, & give feedback  5 Rights of Delegation Task  things that are repetitive * relatively noninvasive  require little supervision * have predictable results  potential for minimum risk Circumstance  patient setting  available resources & other relevant factors Person  correct person performing  correct person receiving Direction  clear, concise description of task (objectives, limits, expectations)  ongoing communication is vital between NAP & RN Supervision  provide appropriate monitoring, evaluation & intervention as needed  NAP should be comfortable asking ?s & seeing assistance Chapter 24: Communication 1. Communication techniques for special needs (i.e. cognitive, hearing loss, vision loss) Cognitive Impairment  use simple sentences  ask 1 ? at a time  allow time for patient to respond  be attentive  include family in conversations Hearing Impaired  reduce environmental noise  get patients attention before speaking  face patient with mouth visible  speak at normal volume  provide sign language interpreter if indicated Visually Impaired  speak in normal tone of voice  use indirect lighting avoiding glare  use at least 14-point print Cannot Speak  listen attentively, be patient, do not interrupt  ask questions that require "yes" or "no" answers  use visual cues  use communication aids 2. Communication techniques (i.e. parroting, clarifying, focusing, paraphrasing) Pg. 320-323 for all 26 Parroting  not the same as paraphrasing! Clarifying (+)  Restate an unclear or ambiguous question to clarify the sender's meaning.  Ask the person to rephrase, explain further, or give an example of what the person means. Focusing (+)  centers on key elements or concepts of a message  do not use to interrupt a patient, but to guide the conversation to important areas Paraphrasing (+)  restating another's message more briefly using one's own words  by doing this, you let the patient know he or she is actively involved in search for understanding 3. SBAR (situation- background-assessment-recommendation): standardizes phone communication of significant events or changes in a patient's condition and is a communication strategy designed to improve patient safety. Pg 358 S Include both admitting & secondary diagnoses & the problem the patient is having as the current issue B Pertinent medical history, previous lab tests, treatments, allergies, & current code status A Include significant findings in head-to-toe assessment, recent VS, recent lab values/results/diagnostics, pain status, and current treatment measures R Suggest a plan of care and what needs to be addressed 4. Communication Types Therapeutic Communication Non-therapeutic Communication  specific responses that encourage the expression of feelings and ideas and convey acceptance and respect  hinder or damage professional relationships  also known as "blocking"  discourage further expressions of feelings and ideas and engender negative responses or behaviors in