Medical surgical nursing- Chapter 1 2023 with 100% correct questions and answers

Define medical-surgical nursing specialty practice area in which nurses promote, restore, or maintain optimal health for patients from 18 to older than 100 yrs What does AMSN stand for Academy of Medical- surgical nursing What is another name for medical- surgical nursing Adult health nursing When is the term "client" used rather than patient in NCLEX Examination Challenge questions What are the roles of a nurse in a medical-surgical setting Care coordinator transition manager caregiver patient educator leader patient and family advocate What does KAs stand for Knowledge, skills, attitudes, and abilities is KAs needed in order to function in various med surgical settings yes What is the Institute of Medicine( National Academy of Medicine (NAM) now) highly respected US organization that monitors health care and recommends health policy, published many reports during the past 20 years suggesting ways to improve patient safety and quality care The National Academy of Medicine's report Health Professions Education: A Bridge to Quality Identified what 5 broad core competencies for health care professionals to ensure patient safety and quality care? -Provide patient- centered care -Collaborate with the interdisciplinary health care team -Implement evidence based practice -Use quality improvement in patient care -Use informatics in patient care QSEN initiative is now called what? QSEN Institute Who validated that IOM ( NAM) competencies for nursing? What competency did they add? QSEN institute Safety What other competencies did the authors of the book add along with the 6 competencies for nursing practice by NAM and QSEN institute? Clinical judgement Ethics Health care organizations Heath care disparities Define how a nurse recognizes patient- centered care and what is implied from the definition Recognizes patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patients preferences, values, and needs (QSEN) Implied the need for culturally competent when caring for diverse patients and their families What term does the Joint Commission use to emphasize the importance of including the patient's support system as part of the interprofessional collaboration Family-centered care Is the Joint Commission a major accrediting organizations for health care agencies? yes, true What type of care has been a focus of health education and research for several decades? Patient-centered care What commission and other organizations called for the rights of patients or designees to make their own informed decisions? Who further emphasized the need for all health care agencies to place patients and their families at center of the interprofessional team to make mutual decisions based on patient preferences 1.Joint Commission 2. IOM ( now NAM) Name the 8 attributes of patient centered care as a result of a classic medical study by frampton et al. Respect for patient values, preferences, and expressed needs Coordination and integration of care Information, communication and education Physical Comfort Emotional Support and alleviation of fear and anxiety Involvement of family and friends Transition and Continuity Access to care What does CAM stand for complementary and alternative medicine Define complementary and alternate medicine (CAM) Supplement to traditional health care to meet preferences of patients and their families Integrative model in response to increasing use of these therapies by consumers to maintain health and help manage chronic health issues What is integrative care, how is it used, and where is it used? Integrative care reflects nursing theories of caring compassion, and holism to respect the diverse preferences and needs of patients and their families Pet therapy, massage therapy, guided imagery, biofeedback, nutritional supplements, music therapy, acupressure, acupuncture, and health-focused television are examples of what? CAM What type of care does the patient need to have after a discharge from a hospital to other inpatient setting? Individualized coordinated care What is the main reason that patients are readmitted after 30 days of being discharged? Lack of coordinated care Define coordinated care the deliberate organization of and communication about patient care activities between two or more members of the health care team to facilitate appropriate and continuous health care to meet that patients needs Who is one of the most important people that need to be contacted when dealing with the patient's care coordination? Case Manager (CM) or discharge planner typically a nurse or a social worker in the health care agencies What is the purpose of the case management process? Who is involved? Propose is to provide quality and cost-effective services and resources to achieve positive patient outcomes Nurse, CM, and other CM that are employed by third party health care payers (Medicare) are involved Transition of care is also known as Transition management Define transitional management involves safe and seamless movement of patients among health care setting, health care providers, and the community for ongoing care to meet patient needs What does the Joint Commission recommend about effective care coordination and transition management? 6 parts Understandable discharge instructions for patient and family Explanation of self care activities Ongoing emergency care information List of community and outpatient (ambulatory care) resources and referrals Knowledge of the patient's language, culture, and health literacy Medication reconciliation Define medical reconciliation formal evaluative process in which the patient's actual current medications are compared to his or her prescribed medications at the time of admission, transfers or discharge to identify and resolve discrepancies Upon admission, transfer, or discharge, what type of information do you need to seek to reconcile medications? drug name dose frequency route purpose The ability to keep the patient and staff free from harm and minimize errors in care is known as what? Safety How does the scope of safety define safe and unsafe? unsafe- possibly causing harm or death safe- prevent harm or negative outcomes Name some reasons that cause patient harm or errors in general Lack of: clear or inadequate information, attentiveness and patient monitoring, clinical judgement, professional accountability and patient advocacy, mandatory reporting. o Is the physician responsible of medication reconciliation ? no, the nursing staff is. This was decided upon the DMAIC (Define Measure Analyze Improve Control) What safety practices reduce error and harm? established protocols memory checklists BCMA( Bar code medication administration) Name and discuss the 3 types of nursing safety priorities 1. critical rescue-emphasizes the need for action for potential or actual life threatening situations 2. Action Alert- need for action but not necessarily for life threatening situations 3. drug alert- actions needed to ensure safety related drug administration, monitoring, or related patient and family education. Who published the National Patient safety goals in 2002? What was it used to establish? JTC ( Joint Commission) -established nursing and health system approaches to safe care What does the National Patient Safety Goals published by the TJC address? high risk issues, such as safe drug administration, prevention of health care-associated infections, and communication effective among inter professional team Health care organizations are required to create a culture of safety as established by what commission? TJC Define a culture of safety Provides a blame free approach to improving care in high risk, error prone health care organizations using interprofessinal organizations By not hesitating to report and document health errors or missed care, you are promoting a culture of what? Culture of safety What other term is used to describe sentinel events? How would you define sentinel events? Adverse events Sentinel events are a severe variation in the standard of care that is caused by human to system error and results in an avoidable patient death or major harm. Are sentinel events required to be reported? If so, by who? TJC What will build a trusted patient and family centered care? open & effective communication mutual respect shared decision making team functioning What does IP stand for Interprofessional What is being promoted when health care organizations are having frequent and regular IP meetings and conducting IP patient care rounds patient and family centered care Name the people who are involved in the interprofessional health care team patient, family, nurses, unlicensed assistive personnel, and other health professionals and their assistants What does UAP stand for and list one unlicensed assistive personnel Nursing assistant Interdisciplinary or multidisciplinary are also considered what type of health care team interprofessional What does IPEC stand for Interprofessional Education Collaborative Name and describe the 4 competencies listed by the Interprofessional Education Collaborative Expert panel 1. Values/ethics for interprofessional Practice:Work with individuals of other professions to maintain a climate of mutual respect and shared values 2. Role- responsibilities: Use the knowledge of one's own role and those of other professions to appropriately assess and address the health care needs of patients and populations served 3. Interprofessional Communnication: Communicate with patients, families, communities, and other health professionals in a responsive manner that supports a team approach to the maintenance of health and the treatment of disease 4.Teams and teamwork: Apply relationship-building values and the principles of team dynamics to preform effectively in different team roles to plan and deliver patient/population-centered care that is safe, timely, efficient, effective, and equitable. What does equitable mean fair Should emails ever replace face-to-face and phone communication? no it should not Who began requiring systematic strategies for improving communication in 2006 TJC Who mandated that nurses communicate continuing patient care needs such as pain management or respiratory support to post-discharge caregiver for safe transition management in 2008 National Patient Safety Goal What was created in order to improve communication between staff members and health care agencies? Procedures for hand-off communication What is one type of formal method of communication between two or more members of the health care? SBAR List and describe what SBAR stands for Situation:Describe what is happening at the time to require this communication Background:Explain any relevant background information that relates to the situation Assessment:Provide an analysis of the problem or patient need based on assessment data Recommendation/Request:State what is needed or what the desired outcome is What does the I, R, Q in I-SBAR and I SBARR Stand for Identify, response, and questions( Any additional) What is TeamSTEPPS, what does it stand for, where did it come from systematic communication approach for interprofessional tea,s that's designed to improve safety and quality STEPPS: Strategies and Tools to Enhance Performance and Patient Safety Adapted from the aviation industry What is TeamSTEPPS suppose to remind us of reminds professionals that mistakes can cause negative outcomes Name the common communication tools as part of TeamSTEPPS that are very important for promoting patient safety and teamwork- 4 tools CUS words:i'm (concerned);I'm (uncomfortable);I don't feel like this is (Safe) Check Backs: restate what a person said to verify understanding by all team members Call outs: Shout important information(such as vital signs) for all team members to hear at one time Two-challenege rule: State a concern twice as needed: if ignored, follow the chain of command to get the concerned addressed What does PCT stand for Patient care Tech What does NA stand for Nurse assistant Define delegation process of transferring to a competent person the authority to perform a selected nursing task to activity in a selected patient care situation Is the PCT, UAP, or NA held accountable for the for the task or activity that has been delegated to him/her no, the nurse is always held accountable Define supervision as a nurse when delegating tasks The nurse will guide/direct, evaluate, and follow up with the task or activity that's been performed by the NA, PCT, or UAP to ensure that the task or activity is performed appropriately What are the five RIGHTS when delegating and supervising a nursing task or activity Right task: The task is within the UAP's scope of practice and competence Right circumstance:The patient care setting and resources are appropriate for the delegation Right Person:The UAP is competent to perform the delegated task or activity Right communication:The nurse provides a clear and concise explanation of the task our activity, including limits and expectations Right supervision: The nurse appropriately monitors , evaluates, intervenes, and provides feedback on the delegation process as needed Define and state what EBP stand for Evidence based practice integration of the best current evidence and practices to make decisions about patient care with considering the patient's preferences and values and one's own clinical expertise for the delivery of optimal health care what is the best source of evidence research What does LOE stand for and what is it used for Level of Evidence It is used to rate the quality( Strength) or scope of available evidence What is the highest level of evidence in a Level of evidence pyramid systematic reviews and integrative or meta-analysis studies How many levels are in the Level of evidence pyramid? State what each level stands for Level 1-(highest/strongest)- systematic reviews, integrative/meta-analysis, CPGs based on systematic reviews, large must-center clinical trials Level 2- single experimental studies Level 3-Quasi-expieremental studies Level 4- non-experimental studies Level 5-Case report/Program evaluation/Narrative literature reviews Level 6- opinions of respected authorities What is EBP based upon? reliable studies, guidelines, consensus, and expert opinion Should nurses respect the values of the patient or designee at all times even if those values differ from their one or those of the interprofessional health care team ALWAYS Health care organizations receiving Medicare and Medicaid are required to follow what type of measure to ensure that the best practices are followed for selected health problems evidence based interprofessional core measures State why many hospitals have or on the path to to achieve the American Nurses Credentialing Center's Magnet Recognition The recognition requires that nurses demonstrate how best current evidence guides their practice . Using research to guide practice is a way to continuously improve quality of care. What does QI stand for quality improvement What does CQI stand for continuous quality improvement Define quality improvement process in which nurses and the interprofessional health care team use indictors( Data) to monitor care outcomes and develop solutions to change and improve care is evidence based practiced improvement is also called Quality improvement because the best sources evidence are used to support the improvement or changes in practice yes What models are used when the patient acre or system care is identified as needing improvement Specific systematic QI models such as the Plan-Do- Study-Act (PSDO) or FOCUS- PDA are typically used List the steps of the Plan DO Study Act PLAN- Identify and analyze the problem DO- develop and test an evidence-based solution STUDY- analyze the effectiveness of the test solution, including possible further improvement ACT- Implement the improved solution to positively impact care List the steps of the more specific FOCUS-PDCA model Finds a process to improve Organize a team Clarify the current process Select the process to improve Plan the improvement DO the improvement Check for results Act to hold the gain What model is gaining popularity as it more clearly delineates each QI step and includes the need to continue the new intervention or change over time DMAIC- Define, measure, analyze, Improve, control What does DMAIC stand for Define- the issue or problem Measure-the key aspects of the current process for the issue ( collect data) Analyze- the collected data Improve-or optimize the current process by implementing an evidence-based intervention/ solution Control- the future state of the intervention to ensure continuity of the process What knowledge and skills will you need as a medical surgical nurse to take part in the QI process 1. Identify indicators to monitor nd effectiveness of health care 2. Access and evaluate data to monitor quality and effectiveness of health care 3. recommend ways to improve care processes 4. implement activities to improve care processes Define what informatics and Technology are the access and use of Information and electronic technology to communicate, manage knowledge, prevent error, and support decision making what does IT stand for information technology What does the EHR and EMR stand for electronic health record electronic medical record What is the largest application of health care informatics EHR or EMR What is another way to say a patient's bedside Point of care (POC) What does POC stand for point of care Taking photos of patients and sharing them with family and friends would be a violation of what Patient privacy and confidentiality What does RFID stand for Radio Frequency Identification What is Radio Frequency identification used for? allows any person or object to be tracked electronically What is the type of process that nurses and other members of the interprofessional team use to make decisions based on interpretation of the patients needs to problems clinical judgement what is another term for appropriate clinical judgements that lead to positive patient or staff outcomes sound clinical judgement What did Tanner 2006 concluded about sound clinical judgment That it is influenced by how well the nurse knows the patient 's typical response pattern and the situational context or culture of the nursing care unit By not knowing the patient's typical response pattern and the situational context or culture fo the nursing care will lead to what Failure to rescue Define failure to rescue inability of nurses or other interprofessional health team members to save a patient's life in a timely manner when a health care issue or medical complication occurs Give an example of Failure to rescue When patient begins to have subtle signs of and symptoms 2-3 days before cardiopulmonary arrest or ,multiple organ failure and the signs/symptoms are not noticed ore accurately interpreted because of this, action to improve the patient's condition was not implemented Does clinical judgement involve specific reasoning and critical thinking skills? If so, state them according to Taylor Assessment: Noticing Analysis: Interpreting Planning and Implementing: Responding Evaluation: Reflecting What team have hospitals established to prevent failure to rescue Rapid response Team What does RRT stand for Rapid Response Team Define the role of the rapid response team to save lives and decrease the rick forearm by providing care before a medical emergency occurs by intervening rapidly when needed for patients who are beginning to clinically decline Who are members of the RRT critical care experts who are on site and are available at any time ICU nurse Respiratory therapist Intensivist (Physician who specializes in critical care) Hospitalist( family practice physician or internist employed by the hospital) In some hospitals, acute care nurse practitioners or medical residents may be part of the team Can a patient family activate the RRT? YES Who requires the need for early intervention for patients who are clinically changing TJC National patient Safety Goal Define ethics according to the ANA a theoretical and reflective domain of human knowledge that addresses issues and questions about morality in human choices, action, character, and ends Ethics are described by what the type of ethics or the setting in which these decisions are made What does organizational ethics refer to the ethical practices of health care organizations ________ for people is the basis for the 6 essential ethical principles that nurses and other health care professionals should use as a guide for clinical decision making are R E S P E CT Define patient autonomy self determination or self management According to the ANA, when the patient is capable of self determination, we are ethically obligated to protect him or her as an advocate within the professional scope of practice False, when the patient is incapable What is the 2nd ethical principle Beneficence, which promotes positive actions towards others encourages the nurses to do good for the patient Define nonmaleficence importance of preventing harm and ensuring the patient's well- being Define fidelity refers to the agreement that nurses will keep their obligations or promises to patients to follow through with care Define Veracity nurse is obligated to tell the truth to the best of his to her knowledge Define social justice refers to the equality and fairness; all patients should be treated equally and fairly regardless of age, gender, identity, sexual orientation religion, race, ethnicity, or education What does HCOs stand for Health care organization What are HCO classified ownership , financial purpose, and mission what does CAHs stand for Critical care Access hospitals What are HCOs characterized by Missiona and philosophy Organizational structure Workforce Patients Service provided Many minority populations have had a high incident of chronic disease and mortality as a result of what health care disparities Is decreasing health care disparities caused by poor communication, health care access, health literacy, and health care provider a focus of the healthy people 2020 initiative yes