LATEST Rasmussen College, Land O Lakes - NUR 3294

NUR3294 Summer 2019 Exam 1 Focused Review • Characteristics of the Nursing Profession • Respond to needs of patients • Actively participate in policy • Respond and adapt to challenges • Make clinical judgments and decisions about patients’ health care needs based on knowledge, experience, and standards of care • Purpose and components of nursing's standards of practice • To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice • Assessment • Diagnosis • Outcomes identification • Planning • Evaluation • Purposes of Code of Ethics • To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice • Differentiate between Educational programs for professional RN • Professional Registered Nurse • 2-year associate degree • 4-year baccalaureate degree • Graduate Education • Master’s degree, advanced practice RN • Doctoral degrees • Continuing and in-service education • CEUs • In-service • Definition of Registered Nurse practice • Protect, promote, and optimize our patients’ health • Prevent illness and injury • Advocate for the care of our patients • Alleviate suffering through the diagnosis and treatment of human responses • Nursing professional responsibilities • For obtaining and maintaining specific knowledge and skills • To provide care and comfort • To emphasize health promotion and illness prevention • Examples of nursing professional roles • Caregiver • Advocate• Educator • Communicator • Manager • What is the importance of Quality and Safety Education for Nurses (QSEN)? • Patient-centered care • Teamwork and collaboration • Evidence-based practice • Quality improvement • Safety • Informatics • What are reason for studying theories and theorists? • Gain understanding of what occurred in the past and events that have shaped what have gotten us to the point we are at today. • Provide research to postulate fresh ideas to gain new insights and advance new technologies. • What are examples of interdisciplinary theory used to guide nursing practice? • Basic human needs • Developmental • Psychosocial • Systems • What are the relationships among nursing theory, the nursing process and patient needs? • The nursing theory drives the process, which in turn directs the care taken to properly address the patient’s needs. • Define theory based nursing practice? • Generate nursing knowledge for use in practice • Can direct how to use nursing process • Are adaptable to different patients and all care settings • The goal of nursing knowledge is to explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines. • Importance of theory based nursing practice important? • Is a conceptualization of some aspect of nursing • Describes, explains, predicts, and/or prescribes nursing care • Know the differences between preventive care, primary care, secondary care, tertiary care, and restorative care (and different types of restorative care) • Preventive care focuses on reducing and controlling risk factors for disease through activities such as occupational health programs. • Primary health care focuses on improved health outcomes for an entire population. It includes primary care and health education, proper nutrition, maternal/child health care, family planning, immunizations, and control of diseases. • Requires collaboration among health professionals, health care leaders, and community members. • Health promotion programs lower the overall costs of health care by reducing the incidence of disease, minimizing complications, and reducing the need to use more expensive health care resources.• Secondary and Tertiary Care • Disease management is the most common and expensive service of a health care delivery system. • Chronic illness causes disability, decreased quality of life, and increased health care costs. • Hospitals • Work redesign • Discharge planning • Intensive care • Psychiatric facilities • Rural hospitals • Restorative Care • Serves patients recovering from an acute or chronic illness/disability • Helps individuals regain maximal function and enhance quality of life • Restorative Care: Home Health Care • Provision of medically related services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation. • Involves coordination of services. • Focuses on patient and family independence. • Usually reimbursed by government (such as Medicare and Medicaid in the United States), private insurance, and private pay. • Restorative Care: Rehabilitation • Includes physical, occupational, and speech therapy, and social services • Begins on admission • Focuses on preventing complications • Maximizes patient function and independence • Restorative Care: Extended Care • Extended care facility • Provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities • Intermediate care/skilled nursing facility • Provides care for patients until they can return to their community or residential care location • Know the difference between hospice, respite care, assisted living, and skilled nursing • Nursing centers or facilities • Assisted living • Long-term care setting • Home environment • Greater resident autonomy • No fee caps• Respite care • Respite care provides short-term relief or “time off” for people providing home care to an individual who is ill, disabled, or frail. • Settings include home, day care, or health care institution with overnight care. • Trained volunteers enable family caregivers to leave the home for errands or social time. • Adult day care centers • Provide a variety of health and social services to specific patient populations who live alone or with family in the community • May be associated with a hospital or nursing home or may operate independently • Hospice • Family centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness. • Focuses on palliative (not curative) care • Many hospice programs provide respite care, which is important in maintaining the health of the primary caregiver and family. • What is performance improvement? • an organization analyzes and evaluates current performance and uses the results to develop focused improvement actions. • What are some examples of quality improvement processes? • Patient Self-Determination Act (PSDA) • Six Sigma or Lean • Rapid-cycle improvement or rapid-improvement event (RIE) • How does technology affect nursing? • Review Institute of medicine nurse competencies • Provide Patient-Centered Care • Recognize and respect differences in patients' values, preferences, and needs. • Relieve pain and suffering. • Coordinate continuous care. • Effectively communicate with and educate patients. • Share decision making and management. • Advocate for disease prevention and health promotion. • Work in Interdisciplinary Teams • Cooperate, collaborate, and communicate. • Integrate care to ensure that it is continuous and reliable. • Use Evidence-Based Practice • Integrate best research with clinical practice and patient values. • Participate in research activities as possible. • Apply Quality Improvement • Identify errors and hazards in care. • Practice using basic safety design principles. • Measure quality in relation to structure, process, and outcomes. • Design and test interventions to change processes.• Use Informatics • Use information technology to communicate, manage knowledge, reduce error, and support decision-making. • Components of achieving magnet status • Transformational leadership • Structural empowerment • Exemplary professional practice • New knowledge, innovation, and improvements • Empirical quality results • What does public health nursing require the understanding of vs community health nursing? • Needs of a population • Factors that influence health promotion and health maintenance • Trends and patterns influencing disease within populations • Environmental factors contributing to health and illness • Political processes used to affect public policy • Community health nursing vs community-based nursing • Community health nursing • Nursing practice in the community • Primary focus: health care of individuals, families, and groups within the community • Goal: preserve, protect, promote, or maintain health • Community-based nursing • Health Promotion • Disease Prevention • Restorative Care • Goals of Healthy People 2020 • Goals are to increase life expectancy and quality of life, and to eliminate health disparities through improved delivery of health care services • Vulnerable populations • Individuals living in poverty • Older adults • People who are homeless • Immigrant populations • Individuals in abusive relationships • Substance abusers • People with severe mental illnesses • Skills and talents of nurses in community-based nursing • Caregiver • Case manager • Change agent • Collaborator • Counselor • Educator • Epidemiologist • Patient advocate • Models of care delivery including case management, total patient care, primary nursing,and team nursing • Traditional models • Team nursing • Primary nursing • Today’s models • Patient-centered care - mutual partnerships among the patient, family, and health care team are formed to plan, implement, and evaluate the nursing and health care delivered • Respect and dignity • Information sharing • Participation • Collaboration • Total patient care • Registered nurse works directly with patient, family, and health care team members. • RN is responsible for patients during shift of care, although care can be delegated. • Approach may not be cost-effective owing to high number of RNs needed. • Patient satisfaction is high • Case management - care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality • Collaborative process of assessing, planning, facilitating, and advocating for options and services to meet an individual’s health 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 the case manager is an advanced practice nurse (APN), who helps improve patient outcomes via specific interventions. • Decentralized decision making • Decentralized management means that decision making occurs at the level of the staff. • Responsibility, autonomy, authority, and accountability- be able to recognize examples of each • Responsibility: duties and activities an individual is employed to perform • Autonomy: independent decisions about patient care • Authority: legitimate power to give commands and make final decisions specific to a given position • Accountability: answerable for the actions • Clinical care coordination • Clinical decision making • Apply the nursing process• Know your patient • Use clinical decision making practices • Accurate clinical decision-making keeps you focused on the proper course of action • Priority setting • Determine which patient’s needs should be addressed first: • High priority: immediate threat to patient survival or safety • Intermediate priority: nonemergent, non–life threatening • Low priority: actual or potential problems may or may not be directly related to patient’s illness or disease • Organizational skills • Do the right things. • Do things right. • Inform and prepare patient. • Clean and organize work area. • Keep patient’s needs at the center of attention. • Use of resources • Appropriate use of resources is an important aspect of clinical care coordination. • Administration of patient care occurs more smoothly when staff members work together. • Time Management • Remain goal oriented. • Identify priorities. • Establish personal goals. • Evaluate • The process • Patient response • Therapy efficacy • Patient and expected outcomes • Team communication • Respect other’s ideas • Share information • Stay informed • Strive to improve communication • Share expectations of communications • Use structured communication techniques • Delegation • Transfers responsibility while remaining accountable for outcomes • Requires knowing which skills are transferable • Results in improved quality, safe patient care, improved efficiency, increased productivity, an empowered staff, and skill development of others • Assess the knowledge and skills of the delegatee. • Match tasks to the delegatee’s skills. • Communicate clearly: • Task, outcome, time • Listen attentively.• Provide feedback. • Knowledge building • Remain competent. • Pursue lifelong learning. • Share the knowledge. • To become a leader, actively pursue learning opportunities, both formal and informal, and learn to share knowledge with the professional colleagues you encounter. • 5rights of delegation • Right Task • Right Circumstance • Right Person • Right Direction • Right Supervision • What tasks can and cannot be delegated to unlicensed assistive personnel? • Do not delegate the steps of the nursing process of assessment, diagnosis, planning, and evaluation because these steps require nursing judgment. • Patient teaching is also the responsibility of an RN and should not be delegated. • As an RN, you are always responsible for the assessment of a patient’s ongoing status; but if a patient is stable, you delegate vital sign monitoring to the NAP. • Appropriate delegation begins with knowing which skills you are able to delegate. Know your state’s Nurse Practice Act. • As a professional nurse you cannot simply assign the NAP tasks without considering the implications. Assess the patient and determine a plan of care before identifying which tasks someone else is able to perform. • Globalization • Evidence-based practice • When does discharge planning start? At admission • Differentiate between ethics and values • Ethics - The study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large. • Values - Personal beliefs about the worth of a given idea, attitude, custom, or object that set standards that influence behavior. • What are examples of ethical principles? • Define Risk Management • A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs • Liability and Nursing Students issues • You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university. • You are expected to perform as a professional when rendering care. • Examples ofnegligent acts • Failure to assess and/or monitor, including making a nursing diagnosis • Failure to notify the health care provider of problems • Failure to follow orders • Failure to convey discharge instructions • Failure to follow policies and procedures• Failure to properly delegate and supervise • Failure to ensure patient safety, especially for patients who have a history of falling, are heavily sedated, have disequilibrium problems, are frail, are mentally impaired, get up in the night, and are uncooperative • Failure to monitor in timely fashion • Failure to use proper equipment to monitor the patient • Failure to document the monitoring • What are examples of Federal statutory issues in nursing practice • Americans with Disabilities Act • Emergency Medical Treatment and Active Labor Act • Mental Health Parity Act • Uniform Anatomical Gift Act • Living Wills, Durable Power of Attorney • Health Insurance Portability and Accountability Act • Advance Directives • Restraints • Differences and similarities in living will, advance directives, durable power of attorney • What are issues related to Ethics of Care? • Quality of life: central to discussions about end-of-life care, cancer therapy, physician-assisted suicide, and DNR • Genetic screening: What are the risks and benefits to individuals and to society of learning about the presence of a disease that has not yet caused symptoms, or for which a cure is not yet available? • Care at the end of life: interventions unlikely to produce benefit for the patient • Access to care: As a nurse, you will certainly deal with ethical issues related to access to care. • Examples. Definition, processing of ethical dilemmas • Step 1: Ask if this is an ethical dilemma. • Step 2: Gather all relevant information. • Step 3: Clarify values. • Step 4: Verbalize the problem. • Step 5: Identify possible courses of action. • Step 6: Negotiate a plan. • Step 7: Evaluate the plan. • Basic philosophies of health care ethics • Deontology - Defines actions as right or wrong • Utilitarianism - Proposes that the value of something is determined by its usefulness • Feminist Ethics - Focuses on the inequality between people • Ethics of Care - Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives • Role of ethics in professional nursing • The Code is written by nurses to express their understanding of their professional commitment to society. It describes the profession’s values, obligations, duties, and professional ideals. • Legal obligations and role of nurse regarding federal laws • Any competent individual 18 years of age or older for himself or herself• Any parent for his or her unemancipated minor • Any guardian for his or her ward • Any adult for the treatment of his or her minor brother or sister (if an emergency, and parents are not present) • Any grandparent for a minor grandchild (if an emergency, and parents are not present)