NUR 445 - Final Study Guide.

Adult Health Study Guide
Introduction:
oPatient education in critical care is ongoing and frequently reinforced
 Use layman terms and stop/explain what you’re doing to family/patient
Patient can be scared when transitioning to independence = help the know this is a good thing oPurpose of the Code of Ethics
Prevention of malpractice or maltreatment of patient
Protects patients and possible healthcare providers Autonomy = independence
Beneficience = do good
Nonmaleficence = do no harm
Justice = be fair
Fidelity – be failthful, truth
oPalliative care – see below
oAdvanced directives – see below Test 1 Chapter 1: Critical Care Nursing Practice
oContemporary Critical Care
Critical care uses a multidisciplinary team
Includes nurses, physicians, clergy, OT, PT, etc.
Each have in depth knowledge
Wide range of discipline = should take advantage of lots of specialties. Diabetes specialties, heart doctor, respiratory, etc. High risk patients
Specialized units
 There is now a continuum of care with critical care
Critical care goes to progressive care
oIn between medical/surgical floor and critical care There are units that are specialized and based on the pts. (age, etc._
oNeonatal (nicu), pediatric (picu), adult, (icu), geriatric etc.
oNot every hospital will have all these designation areas, if a hospital doesn’t have picu, and have a child who is really sick they will transfer them to another hospital. Medical vs. surgical problems
oMedical icu from what’s coming in vs. surgical icu which deals with pts. in critical care after surgery
Special pt. populations
oCardiac, pulmonary, neurologic etc. oCritical care nursing roles
Expanded role nursing positions Case managers Patient educators – diabetes nurse, hand hygiene etc.
Cardiac rehabilitation specialties Office nurses
Infection control specialists
Advanced practice nurse (APNs)
Clinical nurse specialists (CNS) – in charge of leadership type stuff
Nurse practitioner (NP) or acute care nurse practitioner (ACNP) - like a doctor, orders tests, labs, meds
Certified registered nurse anesthetist (CRNA)
The most widespread role of nursing is in direct care for the patient
Our care is also seen in caring with the family of the patient as well. oCritical care professional accountability
The society of critical care medicine (SCCM)
Multidisciplinary, multispecialty, international organization
American association of critical care nurses AACN
Certifications
oHave certifications for different specialties of intensive care such as pediatric, nicu, etc. oHospitals are pushing for nurses to be certified because EBP shows it creates better care
National organizations
Awards
oEvidenced based nursing practice
Research based interventions
Early practice based on traditions
oWe used to do what felt right and what has worked in the past, but this was not always scientific
oNow we focus on evidenced based practice, what research shows work
There is now a shift to use of best data available
oUse science as a base and is able to explain reason for interventions
oCreates more positive outcomes oStrive for best practice
oExample: catheter care – removing quickly, etc
oHolistic critical care nursing
Care
Merges psychological elements with technologic environment Holistic care It can be difficult to give a pt/family more attention because of how fast paced nursing can be Need to make sure they understand we care and promote that. Individualized care
Patient preferences
oBehaviors that indicate we don’t care = rushing, not telling people what/why we are doing things. oYou should focus on the patient, not whats outside the room. Don’t show the pt. you’re stressing out
Patient and family centered care
oInvolving the pt. in care is super important oMake sure they know whats going on. Cultural care
oReflects society
oIncorporates individual differences
oMake sure to include ethnic values in care oComplementary and alternative therapy
Alternative- using specific therapy INSTEAD of traditional treatment
Complementary – ADDING the therapy to the traditional treatment
Examples
Spiritual/prayer – finding meaning and feeling guided
Guided imagery – low cost, decrease stress/pain/anxiety
Massage – promote relaxation, reduce pain Animals – provide positive pt. outcomes with orientation, mobility, communication, and moods oNursing’s unique role in health care Both independent and dependent nursing roles Interdependence with all health care professionals We must be the eyes and ears for the provider
oIs what they are hearing from the pt. what’s actually going on. oExplain, intervene, create best plan of action
oWe need to be professional
oClarify orders We must be exceptional at communication skills Facilitate communication between health workers, family, patiet
Need to communicate with lots of different people in different ways
Assertive in communication
oCritical care nursing practice
Research
Studies link between clinical judgement and interventions Identifies two major categories of thought and action
oNursing thought/action
Clinical grasp
Clinical inquiry
Problem identification
Problem solving
Clinical forethought – preventing problems in the future
oClinical practice Diagnosing/managing functions
Managing a crisis
Providing comfort measures
Caring for families
Prevent hazards
Facing death and end of life care
Communicating/negotiating
Monitoring/managing quality of care
Clinical leadership
oInterprofessional Collaborative practice
Increases quality of care and services
Contains or decreases costs
Core competencies for interprofessional collaborative practice
Assess competencies relevance
Develop plan of action This involves a collaboration between disciplines (doctors, dieticians, therapy, speech
Decrease costs, increase care, better results
Improve communication/accuracy Different departments are experts on different things oPharmacist – meds, dietician etc.
oCare management methods
Care management Enables, supports, and coordinates care
Seen in many settings
Pt. focused, continuum driven, and team approach is goal driven Care manager
oFacilitate care services as a pt. moves through places
Case management Oversees care and organizes services
Collaboration
Case management tools
Clinical algorithm
oDisease population management
Manage the populations’ health over a lifetime
Diabetes, heart failure, etc. oThis is a stepwise decision making flowchart
Helps to guide clinicians through the decision making process
Identify treatments
Ex
Plan for diabetes, first try lifestyle management, then oral diabetics, then insulin
Practice guideline
oResources to help form algorithms oCreated by expert panels and professional organizations Protocol oDirective, useful tool for research studies oDirect plan of action
oDon’t vary
oIf you see a high potassium, don’t give potassium, oRigid guidelines to follow based on what’s going on with the pt. oDo not vary from protocol Order set oPreprinted orders from the provider Helps the order process oExamples
Standard orders for this type of patient which are validated through evidenced based practice Get meds, diagnostics, studies, for certain type of pts. oQuality, safety, and regulatory issues in critical care
Institute of medicine (IOM) report
Publicized a book that reported healthcare harms more people and fails to deliver In healthcare errors happen
oIdentify ways to decrease errors
oCulture of safety, not blame oLook at the big picture, pharmacy sent wrong med, and I gave the wrong med, how can we prevent this from happening Safety as an ethical imperative
Medication administration challenges
oDistraction – distracted by pt., family, phones etc.
oIntentional to prevent distractions oMake sure you do your double checks Important to report errors oExplain what happened, what you are looking for, how to prevent errors again, oNo intimidation
Blameless culture
Intimidating/disruptive clinician Technology
The joint commission
oNational patient safety goals oEnsure high levels of care oEstablishes safety goals in health care organizations
safe medical device act
oserious/potential device injuries should be reported the FDA
oif death is involved = FDA
oimplantable devices = reported and tracked so FDA can learn about issues
privacy and confidentiality
HIPPA
oLaw that allows consumers to have greater access, standardization, and protects information for the pts.
oIncreased regulations and requirements
ICU is an hippa issue
oMany family members, family could overhear, family overhears about other pts., lots of people, tight spaces etc.
oDon’t want family members in the hall way Healthy work environment
Stressful
oThings happen at anytime, it can be hard to work in
oNeed to have support and self-care
Support health care providers
oEBP – unhealthy work increases errors, conflicts, ineffective communication, oIdentify roles we play in healthy work environment
Patient and Family response to the Critical Care experience
oIntroduction
Nurses play a unique role in addressing the needs of patients and families in a busy and complex environment