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Nursing ART
Differentiate between structured and unstructured interviews - Answer-Structured: initial interview~ questions will be more close-ended Unstructured: continuing interview~often opens ended Identify the phases of a therapeutic relationship - Answer-Orientation phase: establish rapport, trust, set ground rules Working phase:addressing goals Termination phase: work is coming to an end Name therapeutic communication techniques - Answer--offering self: stay with your pt -start with a broad opening -restatement -silence -focusing -presenting reality -encourage elaboration -summarizing Identify non-therapeutic communications - Answer-Belittling feelings: Implying clients feelings are insignificant False reassurance: implying that there is no need to e concerned or worried
Parroting: mechanically repeating client words Defending:nurse defends hospital, staff, ect. Introducing an unrelated topic: changing the subject when an uncomfortable topic is introduced Using jargon: specialized language used by a group -Advising: nurse tells client what to do -Requesting an explanation: Asking why, request a reason for feelings or behaviors, client may not know why and it will put them on the defensive Therapeutic communications - Answer-Interview: plan enough time, privacy, identify yourself, verify the person name, explain you propose, use good eye contact, how onto personal question until you get to know the person better Listening: Use short phrases, listen for feelings as well as words, be patient, allow client to finish sentences do not interrupt, allow for pauses and silence, acknowledge non verbal cues and body language Questions: ask main issue first, don't use leading questions, do use expiatory statements, restate the persons own words (reflection), ask open ended questions, avoid close ended questions List the ethical principles pertaining to legal - Answer--self determination -privacy and dignity -anonymity and confidentiality -fair treatment -protection from discomfort and harm civil law - Answer-referred to as private law, it is the body of law that deals with relationship between private individuals, can be subdivided into contract law and tort law Criminal law - Answer-type of public law that deals with the publics safety and welfare, divided into felonies and misdemeanors. e.g. homicide, manslaughter, theft
power of attorney - Answer-Allows p.s to designate another person to make decisions if they become incapacitated and cannot make decisions independently. The surrogate decision maker would then act on a pt.s behalf. identify the 4 requirements for defamation of character - Answer- Explain informed consent - Answer-legal document giving permission for surgical or diagnostic procedure signed by pt or legs guardian; before signing, the physician has explained all aspects of the procedure including risks State the function of scope of practice - Answer-procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. State the function of nurse practice act - Answer-state guideline that governs the practice of professional nursing Medications calculations - Answer-Dose ordered X quantity = On hand Know how to use the four assessment techniques - Answer-Inspection palpation percussion Auscultation Know the steps of the nursing process - Answer-A: assess D: Diagnose
P: Plan I: Implement E: Evaluate Be able to identify a nursing diagnosis with supporting subjective and objective data - Answer- Subjective: Mr. X tells that, I am worried about my disease (prostate cancer). What will be my future? Objective: Pt has poor eye contact, facial expression, clenches hands and restlessness Independent nursing interventions and how to use it - Answer-Autonomous Action that nurses can perform independently based on knowledge and skills, Do not require a doctor's order, May use protocols/standing orders "changed by institution" How to use it: mouth care and vital signs Interdependent nursing interventions and how to use it - Answer-Working with other members of the healthcare team to achieve a common goal. How to use it: MD order for PT to teach the pt crutch walking. The nurse will be responsible for notifying PT and coordinating care to include these sessions. dependent nursing interventions and how to use it - Answer-Prescribed by MD for the nurse to carry out How to use it: medication administration, diet, activity, IV therapy, etc. Be familiar with common nursing interventions - Answer-Assessing,Administering,Assisting, Counseling, Consulting,Coordinating, Collaborating, Managing, Monitoring,Protecting,Referring, Supporting, Sustaining, Teaching Evaluate if goals were achieved - Answer--determine if interventions were done and if the goals were met -contiue/discontinue/identify changes to the interventions
Intimacy vs. isolation (20-40years): individuals face the developmental task of forming intimate relationships with others Generatively vs. stagnation (40-65years): assist the younger generation in developing and leading useful lives Integrity vs. despair (65+years): individuals look back and evaluate what they have done with they lives Systems theory - Answer-p.832 health assessment Hols that a system us composed of subsystems interconnected to the whole system and to each other by means of an integrated and dynamic self regulating feedback mechanism. Rather than individual causing a family problem, the behavior pattern or system causes another behavior. Type of assessment - Answer-p.203 fundamentals Admission assessment Focus assessment Time-lapse Assessment Emergency assessment Admission Assessment - Answer-Initial identification of normal function, functional status, and collection of data concerning actual or potential dysfunction. The purpose are to evaluate the pt.s health status, to identify health concerns that are problematic and to provide an in-depth and comprehensive database, which is critical for evaluating changes in the pt.s health status in subsequent assessments. Baseline for reference and future comparison. This will be done when getting to your room your admitted to. RN perform this assessment Focus Assessment - Answer-Status determination of a specific problem identified during previous assessment. Nurses determine whether the problem still exists and whether the status of the problem has changed (improved, worsened, or resolved).In ICU's may do one every few minutes usually completed every shift. Integrated with nursing care, a few minutes to a few hours between assessments. E.G while bathing a pt that has poor skin the nurse will assess the skin during the bath.
Time-lapse reassessment - Answer-Comparison of pt.s current status to baseline obtained previously detection of changes in all functional areas after an extended period of time has passed. Determines the status of problems already identified, because of the varying time interval between reassessments, a complete review of all health areas is carried out. Several months between assessments. Several weeks or months may elapse between reassessments of a pt in an ambulatory setting. Usually less comprehensive than the initial assessment. Emergency assessment - Answer-Identification of life threatening situation. The pt difficulties involve airway, breathing and circulation the ABC's. Then evaluate the heat, lungs and neurologic status. This is not a comprehensive assessment not enough time to do one. Any time a physiologic, psychological or emotional crisis occur Assessment skills - Answer-Observation: the act of noticing pt cues, pieces of info about a pt.s health status. May be objective or subjective. Nurse uses the sense of smell, hearing, touch and rarely the sense of taste. Begins the moment the nurse meets the pt. Interviewing: Interaction and communication process for gathering data by questioning and information exchange. Usually completed in one session can take up to 30-60 minutes. Can be divided into 4 phases; preparatory (occurs before the nurse meets the pt), introductory(when the pt and nurse meet, get to know each other by the questions asked), maintenance(nurse and pt work toward achieving the specific tasks or goal agreed o in the introductory phase), and concluding(Interview is completed, positive experience for both). Physical Examination: systemic Analysis of bodily functioning using the techniques of inspection, palpation, percussion and auscultation. Assessment activités - Answer-During the assessment phase, nurse collect, validate and organize data. Because these activities are so closely related, shifting from one to another often occurs. E.g. Nurse may choose to validate info as they collect it rather than at the completion of data collection. As they organize data, they may discover ambiguous cues that require further clarification and validation. Nursing diagnosis - Answer-A clinical judgement about ivndidual, family or community responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is acceptable. Types of nursing diagnosis - Answer-Medical dx: pneumonia
the order of nursing diagnosis in terms of importance to the pt. Nurses use assessment skills and data collection, clinical experience and evidence based practice to determine priorities. -Life threatening -Immediate attention -very important to the pt The nursing care plan/planning - Answer-1) Informal Nursing Care Plan
- Formal Nursing Care Plan
- Standardized Care Plan
- Individualized Care Plan Informal Nursing care plan - Answer-Is a strategy for action that exists in the nurse's mind. Ex. Mrs. Phan is very tired. I will need to reinforce her teaching after she is rested. Formal Nursing care plan - Answer-Is a written or computerized guide that organizes information about the client's care. It provides the continuity of care. Standardized nursing care plan - Answer-Is a formal plan that specifies the nursing care for groups of clients with common needs. Ex. all clients with myocardial infaction. Individualized nursing care plan - Answer-Is tailored to meet the unique needs of a specific client- needs that are not addressed by the standardized plan. Activities involved/interventions (implementing) - Answer-Reassess: during each encounter with pt.s, nurse assess function, ensuring prompt attention to emerging problems. Set Priorities: A persons condition changes, priorities also may change that may need to be first instead of the last priority. Perform Nursing interventions: Nurse carries out the nursing interventions listed on the pt plan of care.
Record actions: After carrying out nursing interventions nurse record them in the pt.s health record. Documentation of components of the medical records - Answer--Communication: clear documentation info of the pt and pt care progress to all members of the healthcare team. -Assessment: nurses and other team members gather assessment data from the pt record. -Care planning: Formulation of plan of care flows from assessment data in the pt record. -Legal document: The pt record serves as a legal document of the pt.s health status and care received. -Quality Assurance: An audit is a review records, they serve as quality assurance and reimbursement -Reimbursement: Documentation of pt care provides the basis for decisions regarding care and subsequent reimbursement to the agency. -Research: Nursing and healthcare research is often carried out by studying pt records. -Education: members of the healthcare teach including students of nursing, medicine, and other disciplines use the pt record as an educational tool. Documentation of charting according to guidelines - Answer--Keep confidential all documented info in the client record. Client must also be educated on their rights in relation to HIPPA -Document legibly or print neatly in non erasable ink. Use correct grammar and spelling. Avoid wordiness that creates redundancy. Use phrases instead of sentences to record data -Record data findings, Write entries objectively without making premature judgments or diagnosis. -Record the clients understanding and perception of problems. Avoid recording the work "normal" for normal findings. -Record complete info and details for all client symptoms or experiences -Support objective data with specific observations obtained during the physical assessment. Evaluating client outcomes - Answer-Focuses on the pt and the pt.s function is currently receiving a great deal of emphasis. It determines the extent to which the pt.s behavioral response to nursing intervention reflects the desired pt goal and outcome criteria. Can take place only after standards have been developed. E.g. outcome eval is to establish standards of care for a specific diagnosis and then compare actual pt outcomes with that standard.
Intentional torts of civil law - Answer-Assault and battery: threat of touching and carrying out a threat Defamation of character: false communication Fraud: a nurse who misinterprets their qualifications or bills for care not given may be committing fraud. Invasion of privacy: Nurse in bound to limit discussion about a pt to appropriate parties. False imprisonment: Prevention of movement or unjustified retention of a person without consent may be false imprisonment. Unintentional torts of civil law - Answer-Negligence: neglecting to of something Trends in nursing malpractice: negligence on the professionals part legal aspects Regulation of professional - Answer-Nurses involved in the development of policies, procedures, protocols, or standardized nursing plans of care should be sure to make them realistic for their own practices, for an agency both. legal aspects Regulation of legal - Answer-Nurses need to obtain professional liability insurance to protect their best interests should their practice be call into question through legal action Legal aspects of clients rights - Answer-The AHA created a brochure with six basic right for pt.s and families during hospitalization. In a addition to these rights there are ethical calicoes and legal rules the guide the behavior of healthcare.
- High quality hospital care
- A clean and safe environment
- Involvement in your care
- Protection of our privacy
- Help when leaving the hospital
- Help with your billing claims
Beneficence - Answer-Doing or promoting good, the basis for all healthcare Non-maleficence - Answer-Principle of avoidance of doing them Autonomy - Answer-Degree of discretion and independence a practitioner has Veracity - Answer-Principle of telling the truth, essential to the integrity of the pt-provider relationship Fidelity - Answer-Being faithful to ones commitments and promises Confidentiality - Answer-Practice of keeping pt information private Justice - Answer-Principles of fairness basis of the obligation to treat all pt.s equally and fairly Patient Bill of Rights - Answer-is a list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. Typically a patient's bill of rights guarantees patients information, fair treatment, and autonomy over medical decisions, among other rights. Informal nurse-patient contract - Answer-When the pt and nurse make an agreement thats not through signature Circle of Confidentiality - Answer-Those who have access to a pt.s information like the people in a nursing unit who have responsibility for the pt.s as well as the family, unless the pt objects Advocacy - Answer-Communicating and acting on behalf of another person's welfare, especially a pt in the healthcare system; keeping the pt informed about treatment and nursing care
Negligence - Answer-Failure to do something that a reasonably prudent person would do, or doing something the a reasonably prudent person would not do Malpractice - Answer-Professional misconduct, causing harm or injury to a person from lack of experience, skill, knowledge, or judgment Liability - Answer-Responsibility for one's actions an obligation one is bound to perform Living wills - Answer-Written evidence of a pt.s preferences regarding treatment options Power of attourney - Answer-The authority to act for another person in a specified or all legal or financial matters; legal document giving power of attorney to someone DNR - Answer-Orders not to provide resuscitation in the event of cardiopulmonary arrest Respondent Superior - Answer-"Let the master answer"; doctrine in which a facility is held liable for an employees negligence Good Samaritan Law - Answer-Offers legal immunity for healthcare professionals who assist in an emergency and render reasonable care under such circumstances. False reassurance - Answer-Implying that there is no need to be concerned or worried Belittling feelings - Answer-Implying clients feelings are insignificant Parroting - Answer-Mechanically repeating client words
Defending - Answer-Nurse defends hospital staff, ect Introducing an un related topic - Answer-Changing the subject when uncomfortable topic is introduced Using jargon - Answer-Specialized language used by a group e.g adventitious lungs sounds Advising - Answer-Nurse tells client what to do Therapeutic communication techniques - Answer-Offering self: stay with your pt Start with a broad opening Restatement Silence Focusing Presenting reality Encourage elaboration Summarizing How to listen - Answer--Use short supplementary phases -Listen for feelings as well as words -Allow client to finish sentences do not interrupt -Be patient -Allow for pauses/silence during conversation -Acknowledge non-verbal cues and body language
Self-perceptual/self concept pattern - Answer-Describes the clients self concept pattern and perceptions of self (eg self concept/worth, body image, feeling state) Role-relationship pattern - Answer-Describes the clients pattern of role engagements and relationships Coping-stress tolerance pattern - Answer-Describes the clients general coping pattern and the effectiveness of the pattern in terms of stress tolerance Value-belief pattern - Answer-Describes patterns of values, beliefs (including spiritual), and goals that guide the clients choices or decisions
