NUR2115- Fundamentals of Professional Nursing, Exam #1 Concept Guide,100% CORRECT

NUR2115- Fundamentals of Professional Nursing, Exam #1 Concept Guide Module 1- Wellness, Illness, Client-Centered Care and Evidence-Based Practice: Chapters 1 - 4, 13, 21, and 23 1) Types of wellness, including spiritual, physical, emotional, and sociocultural. • SPIRITUAL: Having peace and harmony in life, in congruence with values and actions. • PHYSICAL: Airway, breathing, elimination, food/drink, and mobility. • EMOTIONAL: Feelings of self-esteem, fear, sadness, loneliness, or acceptance of self. • SOCIOCULTURAL: Feelings of love and belonging. 2) Review WHO (World Health Organization) and their definition of health: Includes physical, social, and mental components and is not merely the absence of disease or infirmity 3) Maslow’s hierarchy of needs • Physiological: Physical needs, such as airway, breathing, circulation, elimination, food / drink, and mobility. • Safety: Environmental, security, housing, and climate. • Love & Belonging: Sociocultural, family, friends, and coworkers. • Esteem: Emotional, ear, sadness, loneliness, self-acceptance, and self-esteem • Self-actualization: Intellectual, having peace and harmony. 4) Evidence-based practice (EBP) Before developing a procedure, a group of nurses on a practice committee review all current research-based literature on insertion of a urinary Catheter. What type of nursing will be practiced based on this review? EVIDENCE-BASED NURSING A problem-solving approach to making clinical decisions, using the best evidence available. Blends both the science and art of nursing so that the best patient outcomes are achieved. 5) Asking Clinical Questions in PICO format Know each segment of PICO • P: Patient, population, or problem of interest • I: Intervention of interest • C: Comparison of interest • O: Outcome of interest 6) Sources of knowledge: traditional, scientific and authoritarian Traditional: Knowledge passed down from generation to generation. Scientific: Knowledge obtained through scientific method and implied through research. Authoritarian: Knowledge that comes from an expert and is accepted as truth based on the person's perceived expertise. 7) Evolution of nursing research and credible resources which can be used KNOW CREDIBLE SOURCES NOT WIWKIPEDIA. -Florence Nightingale kept objective records during the Crimean War, and later went back to see which interventions were most effective to the patients. -As advances were made in technology and medical research during the 20th century, nursing leaders realized that research about the practice of nursing was necessary to meet the health needs of modern society. -During the 1950s and 1960s, nursing research was increasingly recognized as important. Early studies provided the basis for the development of nursing practice standards and the most effective educational preparation for registered nurses. -The 1970s and 1980s focused on clinical research, with published studies of clinical interventions, such as vital signs and treatment procedures. -Credible sources: Journal articles that are peer - reviewed. Nursing research is conducted by quantitative and qualitative methodologies. 8) Common concepts in all nursing theories: Four concepts common in nursing theory that influence and determine nursing practice are (1) the person (patient), (2) the environment, (3) health, and (4) nursing. The focus of nursing, regardless of definition or theory, is the person 9) Stages of illness behavior KNOW THESE STAGE 1: EXPERIENCING SYMPTOMS STAGE 2: ASSUMING THE SICK ROLE STAGE 3: ASSUMING A DEPENDENT ROLE STAGE 4: ACHIEVING RECOVERY AND REHABILITATION 10) Health promotion and illness prevention, including primary, secondary and tertiary prevention • Primary: promoting health & preventing development of disease or injury • Immunizations • family planning • poison-control info • fall prevention education • Secondary: screening for early detection of disease for prompt diagnosis & treatment • Child wellness visits for normal growth & development, routine medical & dental checks • Tertiary: reducing disability after an illness is diagnosed & treated to help achieve maximum level of functioning • Teaching diabetic clients how to prevent diabetic foot ulcers • physical therapy to prevent contractures in an immobile patient • referral to a cancer support group after breast cancer diagnosis 11) Health People 2020 health promotion guidelines SAFETY GOALS OF HEALTHY PEOPLE 2020 -Attain high quality, longer lives, free of preventable disease, disability, injury, premature death. -Achieve high equality, eliminate disparities, improve health of all groups. -Create social and physical environments that promote good health for all. -Promote quality of life, healthy development, healthy behavior across all life stages. 12) National patient safety goals 1. Improve the accuracy of patient identification. 2. Improve staff communication. 3. Improve the safety of medication administration. 4. Reduce patient harm associated with clinical alarm systems. 5. Reduce the risk of healthcare-associated infections. 6. Better identify patient safety risks in the hospital. 7. Better prevent surgical mistakes 13) Roles of the professional nurse IS THE NURSE YOU'RE FRIEND? A RN IS NOT A PRESCRIBER. Caregiver, Communicator, Teacher/Educator, Counselor, Leader, Researcher, Advocate, Collaborator 14) Focus of nursing - To Promote Health - To Prevent Illness - To Restore Health - To Facilitate Coping with Disability or Death To meet these aims, the nurse uses four blended competencies: cognitive, technical, interpersonal, and ethical/legal. 15) QSEN Patient-centered care Teamwork and collaboration Quality improvement Safety Evidence Based Practice Informatics 16) Patient-centered care Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs. 17) Steps of the nursing process and the importance of the nursing process KNOW THE STEPS AND WHAT THEY MEAN AND THE CORRECT ORDER. • Assessing: collecting, validating, & communicating patient data • Diagnosing: analyzing patient data to identify patient strengths & problems • Planning: specifying patient outcomes & related nursing interventions • Implementing: carrying out the care plan • Evaluating: measuring extent to which patient achieved outcomes 18) Competencies in nursing, including cognitive, technical, interpersonal, intrapersonal and ethical/legal • Define cognitive skills in nursing: Using critical thinking, a systematic way to form and shape one's thinking. • Define technical skills in nursing: Manipulating equipment skillfully to produce desired outcome. • Define interpersonal skills in nursing: Promoting the dignity and respect of patients and establishing relationships. • Define ethical/legal skills in nursing: Establishing a personal moral code and professional role responsibilities. 19) Review Erikson’s developmental stages QUESTIONS ON THE STAGES FOR EXAMPLE WHAT STAGE IS 15 YEAR OLD? • Trust vs. mistrust (infancy): birth to 18 months • Autonomy vs. shame and doubt (toddler): 2-3 years • Initiative vs. guilt (preschool): 3-5 years • Industry vs. inferiority (school age): 6-11 years • Identity vs. role confusion (adolescence): 12-18 years • Intimacy vs. isolation (young adulthood): 19-40 years • Generativity vs. stagnation (middle adulthood): 40-65 years • Ego integrity vs. despair (later adulthood): 65 – death 20) The aging adult (physiological changes, dementia, etc.) • Physiologic: Organ systems decline; body less efficient • Cognitive: May take longer to respond and react • Psychosocial: Self-concept is relatively stable throughout adult life • Mental impairment in older adults: Dementia, Alzheimer disease, Sundowning syndrome, Cascade iatrogenesis Module 2- Mobility, Safety, Care Coordination and Documentation: Chapters 6, 7, 11, 19, 27, and 33 1) Review techniques of safety measures Infants: • Avoid risky behaviors during pregnancy • Never leave infant unattended • Safe crib rails • Remove choking hazards • Car seat safety • Handle infant securely- supporting head & neck • Back to sleep Toddlers & Preschoolers: • Supervise child to prevent injury • Bathing, choking, poisoning • Childproof home environment • Toys for developmental age • Manifestations of neglect or abuse • Use car seats properly! • Fire safety & practice emergency evacuation measures School aged children: • Avoid potentially dangerous activities • Safety interventions at home, school, & neighborhood • Teaching about symptoms requiring immediate attention • Immunizations as scheduled • Teach bicycle safety • Teach about child abduction • Wear seatbelts Adolescents: • Safe driving- avoiding distractions • Avoidance of tobacco & alcohol • Firearm safety • Healthy lifestyle- nutrition & exercise • Teach about sexuality, STIs, & birth control • Physical exam before participating in sports • Internet associated dangers Adults: • Effects of stress on lifestyle & health • Safe driving- defensive driving course • Unsafe health habits (drugs & alcohol) • Evaluate workplace for safety • Counsel about domestic violence Older Adults: • Environment safety hazards • Falls, smoke detectors • Defensive driving courses • Regular vision & hearing tests • Signs of neglect & abuse 2) Proper body mechanics The use of proper body mechanics involves bending at the knees instead of the waist to pick items up off of the floor and using the large muscles of the legs instead of the back to lift. It also involves keeping the patient close to your body and the bed at a comfortable working height to avoid leaning or stretching while caring for the patient. The use of proper body mechanics also involves keeping your center of gravity over a wide base of support (your feet) during strenuous activities. When turning, avoid twisting and instead move your entire body in the direction you wish to face. 3) Types of protective positioning of patients, including fowlers, high Fowler’s, semi-Fowler’s, supine, prone, side lying Fowlers: The patient lying in the supine position, bed elevated about 45 degrees Frequently used during procedures such as NG tube insertion and suctioning. Allows for better chest expansion and ventilation, as well as better dependent drainage, after abdominal surgeries Semi-Fowler’s: The patient lying in the supine position, bed elevated about 30 degrees. Frequently used to prevent regurgitation of enteral feedings and aspiration in patients who have difficulty swallowing Supine: When the patient lies flat on their back. Prone: When the patient lies flat on their belly. Side Lying: The lateral aspect of the lower scapula and the lateral aspect of the lower ilium. 4) Assistive devices • The most common include a gait or transfer belt, a transfer board, and a draw sheet. • You'll use a gait belt for patients who need help with ambulation or with transferring from the bed to a chair. • You'll use a transfer board to move a patient from a stretcher to a bed. • You'll use a draw sheet to reposition a patient in bed. 5) Risk factors and interventions to prevent falls and injuries in relation to safety What intervention can be used to help prevent falls and injuries in relation to safety? The use of assistive devices 6) Effects of mobility on the respiratory, cardiovascular, musculoskeletal system, etc. WHAT FACTORS IMPEDE MOBILTY? 7) HOW DOE MOBILTIY HELP RESPIRATORY, CARDIVASCULAR DIGESTION AND MUSCLES AND BONES SYSTEMS CONTRACTURES ALSO URINARY SYSTEM 8) KNOW THE POSITIVE AND NEGATIVE OUTCOMES OF MOBILITY AND IMOBILITY. 9) Types of joint movements, including adduction, abduction, extension, flexion and ROM IF PATIENT CAN DO ROM DURING BEDREST THEY ARE READY TO AMBULATE. • Adduction: towards midline • Abduction: away from midline • Extension: movement that increases the angle between two body parts • Flexion: Flexion refers to a movement that decreases the angle between two body parts. 10) Safety considerations for • Neonates: car seat • Children: seat belt, sexual & physical abuse, emotional signs negligence • Adolescent: motor vehicle accident (alcohol), domestic violence • elderly: falls, overdosing, 11) Restraints and alternatives • Restraints may only be used as a last resort; facility policy and procedures must be carefully observed, monitored, and documented when restraints are in place. 12) Proper documentation guidelines HOW TO DOCUMENT CORRECTLY. • Time, date, objective data, signature • Formats for nursing documentation include the initial nursing assessment, care plan, patient care summary, critical/collaborative pathways, progress notes, flow sheets and graphic record, medication record, and acuity records. • 13) Methods of documentation, including ISBARR : (Identify, Situation, Background, Assessment, Recommendation, Read back/Repeat) SBAR : situation, background, assessment, recommendation DAR : DAR is a form of focus charting and the DAR stands for data-action-response. It ensures documentation that is based upon the nursing process. Routine nursing tasks and assessment data is documented on flow sheets and checklists charting by exception (CBE) : CHARTING BY EXCEPTION (CBE) or variance charting is a system for documenting exceptions to normal illness or disease progression, using a shorthand method of charting what's usual and normal. You make check marks or write your initials in certain places on the CBE flow sheets. This type of charting is often done on flow sheets that are based on preestablished guidelines, protocols, and procedures that identify and document the standard patient management and care delivery. You need to make additional documentation when the patient's condition deviates from the standard or what's expected. SOAP KNOW THESE TYPES HOW DOES A NURSE TRANSFER A PATIENT FROM THE HOSPITAL TO THE LONG TERM CARE FACILITY? • (Subjective data, Objective data, Assessment [the caregiver’s judgment about the situation], Plan); • Safe patient handling and transfers involve the use of patient assessment criteria, algorithms for patient handling decisions, and proper use of patient handling equipment. WHAT COMMUNICATION NEEDS TO BE REPORTED? ALWAYS ORIENTATE YOU'RE PATIENT TO THE UNIT AND THE ROOM. CALL LIGHT, TV, BATHROOM. 14) Shift report WHAT IS SHIFT REPORT? • The trend is toward a standardized, streamlined shift report system at the bedside, which is driven by patient safety and enhanced patient/family participation. • routine occurrences in healthcare organizations that are viewed as crucial for patient outcomes, patient safety and continuity of care. • A proper end-of-shift report is a compilation of details recorded by a patient’s nurse. • An end-of-shift report allows nurses to understand where their patients stand in regard to recovery by providing a picture of a patient’s improvement or decline over the last several hours. By knowing what has previously occurred in a patient’s treatment plan, nurses can proceed with the right steps to contribute to positive outcomes. 15) Incident reports • Reports incident: what happened to patient/ does not go in patient documentation • An incident report, also termed a variance or occurrence report, is a tool used by health care facilities to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a patient, employee, or visitor. These reports are used for quality improvement and are not intended to be used for disciplinary action against staff members. 16) Professional nursing standards UNDERSTAND CODE OF ETHICS AND THE NURSES REPONSIBILITY. • The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity. 17) Code of ethics, ethical distress, ethical dilemmas WHAT IS BIAS, STEROTYPING STIGMA 18) Nursing informatics • Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in their decision making in all roles and settings. 19) Legal regulation of nursing practice 20) HIPAA/patient rights CAN YOU USE YOU'RE PERSONAL EMAIL AT WORK ABOUT A PATIENT? 21) Informed consent KNOW CHARTING BY EXCEPTION WHY IS THIS DANGEROUS? 22) Healthcare trends ACUTECARE VS COMMUNITY HEALTH Module 3- Therapeutic Communication, Cultural Competence, Delegation, Teamwork and Collaboration: Chapters 5, 8, 10, 12 • Cultural competence • Providing culturally competent, or in newer terms, culturally respectful nursing care means that care is planned and implemented in a way that is sensitive to the needs of individuals, families, and groups from diverse populations within society. • Becoming culturally competent is a lifelong challenge. Nurses should strive to be culturally humble---recognizing what we don’t yet know about those entrusted to our care and being willing to learn what we need to know. • Cultural competence takes time. It involves developing awareness, acquiring knowledge, and practicing skills. • Nurses who value cultural competence strive to enhance their understanding of the following: a. Beliefs, values, traditions and practices of a culture b. Culturally defined, health-related needs of individuals, families and communities c. Culturally based belief systems of the etiology of illness and disease and those related to health and healing d. Culturally based attitudes toward seeking help from health care providers KNOW MUSLIM, CHRISTIAN, MORMAN AND PROTESTAN • Stereotyping, • cultural shock • assimilation • blindness • Review interviewing techniques, including open-ended, close-ended, reflective, pauses, silence and clarifying questions KNOW THESE • Barriers to communication a. The failure to verbalize clearly and compassionately blocks effective communication. b. Disruptive behavior has a negative effect on clinical outcomes, patient safety, and interpersonal communication. c. Incivility and bullying, horizontal violence and lateral violence are all forms of disruptive behavior and communication. d. Body language, insensitivity, language barrier, • Therapeutic communication • When developing professional therapeutic communication skills, nurses should develop conversation and listening skills; use silence, touch, and humor appropriately; and improve interviewing techniques. • Review various cultural factors that affect nursing care (including food preferences and other special considerations) • Delegation • RNs may delegate approved skills to UAPs (unlicensed assistive personnel) but should never delegate any elements of the nursing process itself. • Nurse’s role in continuity of care • Continuity of care is a process by which health care providers give appropriate, uninterrupted care and facilitate the patient’s transition between different settings and levels of care. Continuity of care ensures a smooth transition between ambulatory or acute care and home health care or other types of health care settings in the patient’s community. • care coordination: is a mechanism to make sure that patients get the right care at the right time in the most efficient and cost-effective manner, by the right person in the right setting. The aim is to link patients with resources in the community to enhance their well-being, improve information exchange, and reduce fragmentation and duplication of services. • Phases of helping relationships TO ASSIST IN POSITIVE SELF IMAGE THE NURSE NEEDS TO BREIFLY COMMUNICATE CLEARLY WITH ALL NURSING CARE KNOW HOW TO BUILD SELF ESTEEM a. A helping relationship exists among people who provide and receive assistance in meeting human needs. b. A helping relationship has three phases: the orientation phase, the working phase, and the termination phase. • KNOW CULTURAL CONSIDERATIONS SUCH AS ASIAN DECENT IS SILEN DURING PAIN AND DOES NOT GROAN. • DISCHARGE PLANNING TO HOME CHECK FOR PHONE FOR HELP ENVIRONMENT, WOUND CARE AND ADLS The purpose of planning for continuity of care, often called discharge planning, is to ensure that patient and family needs are consistently met as the patient moves from the acute care setting to care at home. Essential components of discharge planning include assessing the strengths and limitations of the patient, the family or support person, and the environment; implementing and coordinating the plan of care; considering individual, family, and community resources; and evaluating the effectiveness of care.