NUR301 Test 1 PDF

NUR 301 test 1 1. **discuss and research a beginning framework for professional nurses in relation to... ** **Nursing process**  Assessment  - Collecting data, subjective/objective  Diagnosis  - analyzing collective data to the situation  outcomes/identification  - Expedition of t...

NUR 301 test 1 1. **discuss and research a beginning framework for professional nurses in relation to... ** **Nursing process**  Assessment  - Collecting data, subjective/objective  Diagnosis  - analyzing collective data to the situation  outcomes/identification  - Expedition of the end goals Planing  - Strategies to achieve expected outcomes Implementation - Doing the plan (coordination and care edu)   Evaluation - Elevate if goals are met or need adjustment  Clinical judgment  - **Nursing process = clinical judgment**  - Using critical thinking skills, decision making, nursing knowledge, pt situation identify, potential problems, and be able to interpret appropriate interventions  - Observe, analyze, and interpret data      Responsibility/accountability  Responsibility  - Obligation and ownership of one\'s actions, decisions, and duties  - **Fulfilling your obligations** - As a nurse make sure standards of practice, hospital regulation, and competence Accountability - Answerable for actions, decisions, and outcomes - Nurses are accountable for all decisions and care that they provide Standards of Practice - Statements that outline the duties and expectations of all RNs  - Describe a competent level of nursing care - Standards are by ANA, regularly reviewed and updated - Nurses 101 Guide Interprofessional Communicationn - Exchange of information between two persons or among persons in a small group QSEN Standards (Quality and Safety Education for Nurses) - Quality and education for nurses - These standards define the knowledge, skills, and attitudes nurses should develop to improve the quality and safety of healthcare systems.  - Focuses on patient-centered care and collaboration, evidence-based practice, quality improvement, safety, and informatics (using information technology to communicate, manage knowledge, mitigate error, and support decision making)  Develop an understanding of the role and regulation of Nursing care as described by the NC Nurse Practice Act NC Nurse Pratice Act  - **Rules and regulation of nursing care ** - Establishes the legal scope of nursing pratice in the state - Role and scope - The NPA is intended to protect the public by ensuring that only qualified individuals pratice nursing  Licensure - Pass NCLEX-RN - Same in every state  - **Standardized minimum knowledge base**  Certification - Ongoing continuing edu and maintaining a set number of hrs in clinical/administrative pratice  Identify ethical concepts as set forth by the ANA Code of Ethics. - Outlines ethical key principles that guide nursing pratice  - **Right and wrong ** Principals - Advocacy  - Responsibility/accountability  - Confidentiality - Respect for human dignity - Nurses must treat pt with respect regardless of personal beliefs or circumstances - Social Justice  - Prompt human rights and act to prevent discrimination abuse, and unethical practices  2. Topic: Informed Caring Caring Theories: Caring theories provide a framework for understanding the behaviors and processes that characterize caring in nursing practice **Swanson Theory of Caring:** Nurturing way of relating to an individual  - [Knowing]: Understand an event as it has a meaning - [Being with]: Emotionally present  - [Doing for]: Doing as how you would do for yourself  - [Enabling]: Facilitating others passage through life transitions - [Maintaining Belief]: Sustaining faith in other capacity to get through a situation.  **Watson\'s Transpersonal Caring:** [Central focus of nursing]. Need conversations that are meaningful and address patients\' needs.  - It supports nurses\' conscious intention to care and promotes healing and wholeness.  **Leininger's transCULTURAL caring:** Set nursing apart from other healthcare disciplines. Need to apply cultural caring for patients. - emphasizes the importance of understanding and incorporating a patient\'s cultural beliefs, values, and practices into their nursing care. - Leininger\'s theory recognizes the influence of culture on everything involving a patient, including health beliefs, family roles, community involvement, and dietary practices. Nurses must safely integrate patients\' cultural traditions, values, and beliefs into their plan of care. Discuss the concept of caring in the role of a nurse. - See the pt within (knowing, recognizing pt problem, find and implementing pt center care.  - It involves establishing a therapeutic relationship with patients - Means being present, listening, and responding to the unique needs and concerns of each pt - Requires nurses to treat pt w/ respect, empathy and dignity [no matter what] - Involves **advocating** for pt, promoting their **autonomy**, **ethical**, and empowering them to be active in their care  - Environment of trust, comfort, and healing  Describe how personal beliefs and values of both nurse and client influence health care - Shape both the nurse and clients **perceptions, behaviors, and decision making related to health ** - Client: -  Health beliefs: based on reality, misinformation, or personal experiences  - Example: adhering to treatments, following preventive measures, or engaging in risky behaviors - Values: Culture and faith, impact on health, illness, and acceptable treatments.  - Nurses: - Affect clinical judgment, care planning, and ability to establish a therapeutic relationship with the client - **Crucial**:  - Recognize own values and beliefs, and avoid making judgments when client's views differ from their own - Strive to understand and respect the client's belief system and values, and incorporate them into individualized care plans Identify the role of the nurse as it applies to the inclusion of family and support systems in the care of the individual. - Forming caring relations with families=essential  - Apply effective communication while considering the complexities of family dynamics, needs, and relationships - Goal:  - Help families and individual members achieve and maintain optimal health throughout and beyond illness experiences - **Nurses**: Advocate for families across practice settings and healthcare environments - Crucial in health promotion, illness prevention, disease management, and end-of-life care.  - Encompasses autonomous and collaborative care that extends beyond the individual patient to include families  - Promoting a safe environment, education, and advocacy are **key** nursing responsibilities when including families in patient care.  Describe characteristics of caring in Nursing Practice Presence- Conveying a closeness and sense of caring. "Being there" and "being with." **Connectedness between nurse-patient  ** Touch- Comforting approach that reaches out to the patient to communicate concern and support. **Leads to a connection between nurse and patient contact or non-contact.** Listening- **Silence yourself and listen with an open mind.** Present and engage the patient in a non-judgmental and accepting manner.  Knowing- **Core of nursing\*** Occurs over time and develops within the context of nurse-patient relationship. **CRUCIAL** Spiritual Support- **Sense of connectedness.** Can affect physical well being. Find balance between life, values, goals, belief system, and those of others Relief of symptoms- Caring presence helps set desired outcomes for symptom relief. **Requires patient-centered caring actions that gives patients comfort, dignity, respect, and peace. ** Family/Support system care - **Encourage family to be active in patient care.** Caring for family can influence the patient\'s illness and stress.  Identify how social determinants of health and health care disparities influence informed caring. **Social Determinants and Health Care Disparities** - Aware of how factors like economic stability, education access, neighborhood environment, and social context can impact a patient's health outcomes and ability to access quality care.  - [Understanding helps with]: Providing more culturally competent and equitable care tailored to patient's unique circumstances and needs **Health Care Disparities Linked to**  - inadequate resources  - poor communication - lack of culturally appropriate care - language barriers  - All can hinder the nurse-patient relationship and the patient's ability to fully engage in their care Recognizing and addressing:  - Advocate for their patients  - Promote health literacy - Deliver truly informed compassionate care - All consider the whole person within their social context  3. Collaborative Communication Describe elements of communication in professional nursing practice. - **[Intrapersonal Communication]**: Reflection on one's own thoughts and feelings to enhance self-expression and therapeutic relationships with patients - **[Interpersonal Communication]**: One-on-one interactions with patients, families, and healthcare team members - [Effective]: active listening, empathy, and respect for the patient's beliefs and values. - **[Critical Thinking]**: Gather comprehensive information, analyze findings, make clinical judgments, and plan patient-centered care that promotes understanding and effective communication  - **[Therapeutic Communication]**: Empower patients, build trust, and facilitate the healing process - Include respecting patient autonomy, promoting self-expression, and providing emotional support - **[Cultural Competence]**: Understanding and respecting cultural differences, beliefs, and values to communicate effectively and provide culturally appropriate care - **[Collaboration]**: Communicating and coordinating care with interdisciplinary healthcare teams, patients, and families to achieve positive patient outcomes - (Extra one): [Interdisciplinary Communication]: Communication between healthcare workers.  **[Apply accepted standards in client charting.]** - Timely manner - Clear and concise  - "Continue to monitor"= **BAD** - Be thoroughly about **EVERYTHING** - **If you did not document it, it did not happen** - Don't include incidents in client charting - Make sure to chart abnormality (be detailed)  - Set smart goals: specific, measurable, achievable, relevant, time frame  Demonstrate the use of SBAR. - **Situation, Background, Assessment, Recommendations** - Communication technique used by healthcare professionals to convey important patient information in a clear and concise manner. Describe the legal and ethical concepts associated with electronic documentation and an electronic health record. - Privacy and Confidentiality: HIPAA Regulations - Information Security: Logical and Physical restrictions to safeguard sensitive patient information. **Strong passwords and constantly changing passwords. ** - Ethical Use: Providing care, billing, or education-based research.  - Unauthorized purposes: violates patient privacy and trust - Documentation Standards: Accurate, timely, and comprehensive documentation:  - Crucial:  - Quality care, interprofessional communication, legal records, and billing justification  Discuss aspects of communication with interdisciplinary professionals. - Collaboration, clear and concise communication (SBAR), Active listening, conflict resolution, and documentation   Utilize therapeutic communication techniques. - Open-ended questions: Listening and validates patient's emotions - Reflecting: Listening and validates patient's emotions - Silence: Gives patient time to process and continue sharing - Empathy: Builds trust and shows you care - Therapeutic touch: Gentle touch on arm or hand - Examples of non therapeutic communication:  - Giving advice or making judgments: "You shouldn't worry so much about the surgery" (dismisses patients feelings and concern). - Asking leading questions- influence patients response  - Changing the subject: Avoids addressing patients expressed thoughts/emotions - Using cliches: "Everything will be just fine." (Insincere and minimize patients experience) 4. Legal and Ethical Concepts in Nursing - Nurse Practice Acts define the laws and regulations governing nursing scope of practice in each state - The ANA Code of Ethics establishes the ethical standards and principles nurses should uphold, such as advocacy, responsibility, accountability, and patient confidentiality. Nurses must incorporate these ethical tenets into their practice. - Policies and procedures at the healthcare facility level aim to implement broader laws and ethical codes. Nurses must follow facility policies to mitigate legal risks. - Overall, safe and ethical nursing care requires integrating legal statutes, professional ethics codes, personal values, and institutional policies into clinical judgment and decision-making.  Identify contemporary ethical issues pertinent to nursing **[Social media use]** - The materials discuss the ethical challenges social media presents for nurses:  - risk to patient privacy when posting information or pictures, even without identifiers.  - Going Online interactions with patients also risk blurring professional boundaries. **[Quality of life ]** - While not explicitly mentioned, ensuring quality of life for patients is an important ethical consideration in nursing care and treatment decisions. **[Access to healthcare]** - The materials do not directly address access to healthcare as an ethical issue - Nursing equitable access to quality healthcare is a core ethical principle in nursing. Explain principles and approaches commonly used in health care ethics discussions. - Philosophical approaches like **utilitarianism** (focused on promoting the greatest good for the **greatest number**), **deontology** (focused on **moral rules and duties**), and **virtue ethics** (focused on virtuous character traits) can help interpret and address ethical issues - gathering information, identifying ethical elements, defining the problem, listing possible courses of action, deciding on an action, implementing it, and evaluating the outcome. - Ethics committees at hospitals facilitate clinical ethics consultations, policy development, and education on topical ethics issues. They provide a forum for all perspectives to be heard when working through ethical dilemmas Identify federal statutory guidelines in nursing practice. **[EMTALA - The Emergency Medical Treatment and Labor Act]** - Prohibits the transfer of patients from private to public hospitals without appropriate screening and stabilization - It is intended to prevent **patient dumping** - This act ensures that patients are medically screened when they come to the emergency department or the hospital. Staff must assess all patients who enter the hospital and cannot discharge or transfer them until their conditions stabilize **[Uniform Anatomical Gift Act]** - Provides the foundation for the national organ donation system - It allows individuals aged **18 or older** to make an organ donation in writing, such as by signing the back of their driver\'s license.  - The UAGA is based on ethical principles of patient autonomy, individual autonomy, and public trust regarding organ donation. **[Mental Health Parity Act]** - [Requires] health insurance companies to provide coverage for mental health and substance use disorder (SUD) treatment - It prohibits insurers from discriminating against or denying coverage to patients with mental illness or SUD due to pre-existing conditions. - **aims to ensure parity (equality) in the provision of mental health, behavioral health, and SUD services compared to medical/surgical services.**  \- **[Identify state statutory guidelines in nursing practice.]** - [North Carolina Nursing Laws and Rules] - Legal scope of nursing practice in state - Standards for licensure, education requirements, grounds for disciplinary action, and regulations around prescribing authority - [Good Samaritan Law] - Legal protection for healthcare professionals  - Limits liability as long as the care provided was reasonable and acted in good faith - **Does NOT protect if practice outside of scope** **[Discuss the nurse's role in the consent process.]** - Witness patient signing consent form after HCP (Healthcare provide) explained the procedure, risks, benefits, and alternatives.  - The nurse\'s signature verified patient appeared capable and gave voluntary consent.  - Ensure the patient understand the information provided and has an opportunity to ask questions before signing  - **ANY concerns about the PROCEDURE, nurse should NOTIFY the provider. ** - **Nurse, especially nursing students, should not obtain consent themselves or be responsible for the legal consent process, that is the DUTY of provider performing the procedure. ** **[Discuss the legal significance of charting, to include HIPAA]** - Accurate and timely documentation - Patient privacy and confidentiality is under HIPAA. Must protect patient privacy by only accessing records for legitimate care purposes and following protocols to maintain information security. **Identify measures to reduce legal risk** - Use clinical judgment to identify patient needs and make sound decisions  - Remain attentive to patients - Provide accurate patient education and ensure understanding  - Obtain informed consent  - Document clearly and timing, alerting providers to changes in patient status - Avoid posting patient information or workplace details on social media - Clarify unclear orders  - Advocate for patient safety concerns - Remain involved in the nursing profession to stay up-to-date.       Define the following terms - Malpractice - professional negligence that **causes** **harm** - Negligence - **Failure** to act w/ the care expected of a reasonable person  - Tort - **Civil** wrongful acts or **omissions** of care made against a person or property  - Assault - **Threat** of harm causing fear of imminent harm  - Battery - is any intentional offensive **touching** without consent or lawful justification - Criminal law - governing **crimes** and **punishment**  - Civil law - **governing** disputes between **individuals**/organizations - Common statutory law - based on **court** rulings and **precedents** - Regulatory law - rules created by **gov** **agencies**  - Slander - occurs when one **speaks** falsely about another. - Libel - is the **written** defamation of character (charting false defamatory entries in a medical record)  - Beneficence - refers to taking positive actions to help others (Think: **What would be beneficial with everyone)** - Fidelity - refers to **faithfulness** or the agreement to keep promises  - Justice - refers to **fairness** and the distribution of resources (Think: **What would be fair for that specific person)** - Non-Maleficence - refers to the **avoidance** of harm or hurt. In health care, ethical practice involves not only the will to do good but the equal commitment to do no harm (think:\ :non = none mal = bad) - Ethical Dilemma - An ethical problem is called a dilemma when **two opposing courses of action can both be justified by ethical principles. ** 5. Evidence Based Practice  Define evidence based practice - involves nurses addressing clinical problems by looking for the very best knowledge and scientific and clinical evidence that are available for treating or managing patient problems and implementing changes in practice. Discuss methods to collect evidence based practice. - Textbooks that incorporate evidence into the information, practice guidelines, and procedures they include - Articles from nursing and healthcare literature available in journals/the internet - Practice guidelines and protocols that are updated regularly based on new evidence - Policies and procedures that are required to be evidence-based in many healthcare organizations. - Involving staff nurses and advanced practice nurses to review scientific articles relevant to policies and procedures and make revisions based on the latest evidence. - **obtain the most relevant, current, and accurate information from reputable sources when making clinical decisions for patient care.** - **No more than 5 years ago!** Describe how evidence based practice informs clinical judgment. - critical element that **informs and shapes clinical judgment in nursing** - Evidence-based practice provides nurses with the best scientific evidence to apply to recurrent patient health care problems, rather than relying solely on information gained during education or experiential knowledge - By implementing this nurses can **deliver safe, effective, and state-of-the-art care, ultimately improving patient outcomes.** Describe the difference between a scholarly source and a public source. - **Scholarly Sources** - are authoritative, peer-reviewed, and detailed, aimed at advancing knowledge within a specific academic or professional field (**BEST)**. - **Public Sources** - are designed for general consumption, providing broad information and often lacking the detailed analysis and rigorous review found in scholarly sources. - For academic work, especially in nursing, scholarly sources are preferred due to their reliability and depth, while public sources can provide supplementary or general information. Differentiate the primary difference between qualitative and quantitative research methods. Quantitative research  - relies on methods that precisely **measure** and **quantify** a study\'s variables. It focuses on **numerical** data, statistical analysis, and controls to eliminate bias in findings. - Example: CAUTIS: Lots of UTIS (counting, correlation) Qualitative research  - studies phenomena that are difficult to quantify or categorize, such as patients\' perceptions of illness or quality of life.  - This research method **describes** information obtained in a **non-numeric form**. Data are typically gathered during **interviews** and the **findings** have **depth** because patients are **descriptive** in what they share. - **What can we do to stop it** - Example: CAUTI: What do we need to do to the patients with catheters, ask the "why" question.  - DO: Foley care, sterile buddies, change foley frequently, and remove it sooner.  Discuss the concept of evidence based practice as it relates to performance improvement. - research, and performance improvement (PI) are closely interrelated and exist along a continuum of clinical scholarship. - All three processes require using the best evidence to provide the **highest quality of patient care** - EBP (Evidence Based Project), it is important to first review evidence from appropriate research literature as well as PI data, when available.  - PI data inform you about how processes work within an organization and thus offer information about how to eventually make EBP changes - The key to integrating evidence successfully is to increase buy-in by involving as many staff as possible to champion the EBP process by focusing on a problem that is **important to them.** - It is often best to test a new practice change by conducting a pilot study before implementing on a large scale. The results of the pilot tell you whether the practice change can be implemented easily and whether it results in desired outcomes. - **Evidence based practice leads to quality improvement (Think, for CAUTI example; after the research is obtained no quality improvement has been achieved YET. When the research has been implemented and the infection decreased that is quality improvement)**