NUR270 FINAL EXAM Spring QUESTIONS AND ASNWERS 2022

NUR270 FINAL EXAM Spring QUESTIONS AND ASNWERS 2022 #45- Safety -6 Safety Definition: • Freedom for accidental injuries • Establishment of operational systems and processes • Minimize likelihood of errors • Maximize likelihood of intercepting errors when they occur --preventing accidents, injuries, mistakes and harm to patients Types of Errors • Commission • Omission • Execution Levels of Errors • Adverse – unintended harm • Near miss – could have harmed pt but did not • Sentinel – involves serious injury and or death Categories of errors • Diagnostic • Treatment • Preventive • Communication Scope of errors • Active – bedside, active pt care • Latent – blunt end, organizational/system SBAR- situation, background, assessment, recommendations Five Rights of Medications • Right patient • Right drug • Right dose • Right route • Right time When using safety devices (restraints—chemical or physical) • Assess every 2 hours • Order needed by DR every 24 hrs • Remove restraint periodically to perform ROM • Offer toileting, fluids, fluid every 2 hours • Evaluate restraint • Document IOM 6 competencies • Safety – avoid injuries • Timely – reduce wait times • Effective – providing benefitting services • Efficient – avoid waste of equipment, supplies, ideas, and energy • Equitable – providing equal care to every patient • Patient centered – providing care that is respectful and responsive to patient CMS – drives quality measures for Medicare and Medicaid patients by “conditions of participation” –respond to “never events”—serious costly errors that should have never happened – they will no longer pay the additional cost of hosp stays of these: • Wrong site surgery • Mismatched blood transfusions • Patient falls • Hospital acquired infections TJC- The Joint Commission – one of the first accreditation agencies to embrace QI principles as an accreditation requirement in hospitals –purpose is to promote specific improvements in patient safety • Collect standardized measures o Patient safety o Patient rights o Patient treatment o Infection control PDCA cycle • Plan – develop action plan • Do – take action • Check – make adjustments as needed • Act – implement Root Cause Analysis – used to understand the systems at fault within the organization so that improvements can be made and implemented National Pt Safety Goals (7) • Identify patients correctly • Improve staff communication • Use medications safely • Use alarms safely • Prevent infection • Identify patient safety risks • Prevent mistakes in surgery NDNQI – national database of nursing quality indicators – established by ANA • Provide comparative data • Acquire national data QSEN – quality and safety education (6 competencies) • Patient centered care • Quality improvement • Teamwork and collab • Evidenced based practice • Safety • Informatics COMMUNICATION – main issues for errors!! #38- Clinical Judgement- 9 • Definition: Interpretation of a patient’s needs, concerns or health problems and the decision to take action (or not), to use or modify standard approaches or to improvise new approaches on the basis of a patient’s response. Clinical reasoning – thinking process of a nurse used in clinical setting to select best actions for the situation Critical thinking – considering what is important Clinical Judgement Models NCSBN – recognize cues, analyze cues, prioritize hypotheses, generate solution, take action, evaluate outcomes Nursing process – assessment, analysis, planning, implementation, evaluation Tanners Model – noticing interpreting, responding, reflecting Prioritization • Determining which client needs the most attention the fastest • Nurse needs to manage time and establish order for completing responsibilities • Systemic before local (life before limb) • Acute before chronic • Actual before potential problems o Listen to patients o Trends vs transient • Medical emergencies vs expected findings Maslows – have to take care of basic needs first • Self actualization • Self esteem • Love/belonging • Safety and security o Physical safety/psychological safety • Physiological o Oxygen, fluids, nutrition, body temp, elimination, shelter Time Management • Planning o Make to do lists o Set priorities o Schedule activities • Organizing o Declutter o No detour – one task at a time o Mental/physical waste – organize your mind o External distractors ▪ Interruptions, lack of information, ineffective communication o Internal distractors ▪ Procrastination, inadequate planning, failure to set goals • Implementing o Attack priorities first o Avoid procrastination o Delegate appropriately o Control interruptions o Learn to say no o Use technology Delegation –ANA determined • Transferring responsibility while retaining accountability for the outcome • RN responsible for the following o Determines pt needs –assess pt before delegating o Being available to delegatee o Assessment and follow up evaluation o Do any interventions needed • LPN/UAP responsible for the following o His/her actions o Accepting delegation within competency levels o Communicating with delegator o Completing the task • What can NOT be delegated -TAPE--teaching, assessment, planning, evaluation o Initial assessments o Nursing diagnosis o Nursing care goals o Nursing plan of care o Patients progress o Health counseling or teaching o Activities that require specialized nursing knowledge, skills, or judgement • Five Rights of Delegation o Risk task o Right circumstances o Right person o Right direction and communciatino o Right supervision and evlaution #47- Evidence- 6 Definition: testimony of facts tending to prove or disprove any conclusion or something that furnished verification Attributes of evidence • Replicability – verified –repeated o Same results o Same method used • Reliability o Consistent and accurate – like someone you’d want to work with • Validity o Successfully measures what study was set out to measure Types of evidence studies • Quantitative research o Objective data – observation and validation o Numerical date obtained – statistics o Randomized controlled double blind study ▪ Gold standard ▪ Least amount of bias ▪ Randomly assigned to experimental group • Cohort studies • Longitudinal studies • Case controlled studies • Case reports • Qualitative research o Answers questions o Subjective data ▪ Surveys ▪ Questionnaires ▪ Interviews o Looks for patterns or themes o Focus is on patients experience or perspective o Uses textual analysis not numbers • Mixed design research o Uses both qualitative and quantitative approach • Pilot study o Small scale o Identifies strengths of a planned larger study o Identifies limitations of a planned larger study o Discovers preliminary outcomes Critically appraised evidence • Scientific Rigor o Critiquing the evidence ▪ Believability ▪ Credibility ▪ Quality o Bias ▪ Influence on research • Reduce bias by randomization of subjects • Using a double blinded method Advantages of evidenced based practice in nursing • Improves patient outcomes through superior care • Maximizes providers time and reduces cost • Adds new contributions to the science of nursing #44- Collaboration- 7 Collaboration is a development of partnerships to achieve the best possible outcomes that reflect the needs of the patient, family, or community, requiring an understanding of what others have to offer. 4 types of collaboration • Nurse to patient o Nursing process (ADOPIE) • Interorganizational o Collaborations between health care deliverers to pool resources or information to benefit patients and communities • Nurse to nurse (intraprofessional) o Floor nurses, nurse manager, nurse educators, advanced practice nurse, novice nurse, expert nurses • Interprofessional o Working across professional disciplines to optimize patient care o Nurse, doctor, pharmacist, dietician, chaplain, PT, speech, OT, social worker, RT o Attributes – values and ethics, roles and responsibilities, communication, teams and teamwork o Involve patient/family in care o Benefits – decreases medical errors, patient readmission rates, length of stay, patient charges, improves quality care, patient satisfaction Mentoring Mentoring is described as purposeful activities that facilitate the career development, personal growth, caring, empowerment, and nurturance that are important to nursing practice and leadership. --personal relationship between two nurses Characteristics • Inexperienced vs experienced nurses • Interactive process – ask quewtions, talk about concerns, help, set and reach realistic goals, provide emotional support • Long term relationship (at least 2 years) • Voluntary • Career development Mentor Role • Acquiring knowledge, skills and socialization • Recognize strengths/weaknesses • Set/reach realistic goals • Provide emotional support • Validate intuitive thinking • Help development of organization skills and judgment skills Steps in finding a mentor • Determine what want to learn or improve • Pick nurse that is good role model • Think about your strengths and weaknesses • Think about convenience • Ask to be your mentor Ethics committee • Requirement of every hospital • Anyone’s associated with patient’s direct care can request consultation from ethics committee #43- Communication- 5 Definition: Interchange of information, thoughts, or ideas between two or more individuals. Elements of communication • Who relays the message • What is the message • In what way is the message relayed • To whom is the message relayed • With what effect is the message received Three primary components of communication • Sender • Message • Receiver Subcomponents of communication • Interpretation o Context and environment o Precipitating event o Preconceived ideas o Style of transmission o Past experiences o Personal perceptions • Filtration o Filter through info received o Too much filtering means you may miss vital info • Feedback o Response from receiver o Receiver interprets and filters through message o Sender begins the same process of feedback to receiver o Nonverbal communication is assessed through process o –formed on the basis of your interpretation and filtration Modes of communication • Verbal o SPOKEN word o most common! • Nonverbal o Eye contact, body tension, facial expression, touch, posture, dress o If verbal and nonverbal don’t agree nonverbal will be believed! • Electronic and Written o Accuracy o Thoroughness o Attention to detail o Conciseness o Effective documentation is essential for safe, quality, evidenced based nursing practice Positive communication techniques • Developing trust – essential!! Honesty, integrity, dependability • Don’t use “you” messages o Accusatory and defenses go up • Use “I” messages o Less accusatory o Ex: I felt upset when I find a cluttered room • Establish eye contact o Shows undivided attention • Keep promises o Breaking them destroys trust • Express empathy o Ability of placing oneself is another person’s situation • Use open communication o Open ended questions or statements • Clarifying information o Feedback needed to be certain they received correct message • Being aware of body language • Using touch o Be aware of cultural differences Negative communication techniques • Closed communication styles o Crossing arms, hands on hips o Avoiding eye contact o Turning away or moving away from individual • Blocking o When nurses answer with noncommittal or generalized answers ▪ Ex: I’ve need had surgery before, I am scared” and nurse responds with “oh you’ll be fine” • False assurances o Showing lack of concern or lack of knowledge • Conflicting messages o Verbal and nonverbal messages do not agree • Logical Fallacies o Faulty thinking that affects communication process o Related to culture, gender, background and personal experiences o Inability to separate moods, thoughts, and perceptions in communication ▪ Examples • ad hominem abusive – mudslinging o attack the person instead of the issue • appeal to emotion o attempt to manipulate persons emotion • red herring – smokescreen o introducing irrelevant topic to divert attention of real issue Communication styles • assertive o healthiest form of communication o states wants, needs, desires, and feelings using objective, direct comments o uses active listening o values opinions of others • aggressive o makes decisions for self and others for them to look good o commanding, dominant, and superior attitude o blames or puts down others • passive communication o allows others to make decisions for them o apologetic o seems disconnected and fails to say what is meant • passive aggressive o avoid direct confrontation o manipulate others to achieve personal goals o appear to be honest but aren’t Cultural diversity • sensitivity to cultural differences is an integral part of the nurses responsibility • language barriers • slang terms • misunderstanding occur due to communication differences o direct eye contact o touch o gestures Conflicts in communication • information o one person has info other does not o two people have diff sets of info • perception o people see things differently #37- Professional Identity- 7 • Definition: “A sense of oneself that is influenced by characteristics, norms, and values of the nursing discipline, resulting in an individual thinking, acting and feeling like a nurse.” Attributes • Doing – incorporating professional standards and skills • Being – doing the right thing even when no one is looking • Acting ethically – being attentive to what is right • Flourishing – lifelong growth as a professional • Changing identities – evolving Patient Advocacy – “cornerstone of the nursing profession” – patients depend on the nurse to ensure they receive quality care and safe care Whistle Blower Protection Law • Protects nurses who speak out about unsafe situations • Have your facts straight, document, and keep copies Needlestick safety and Prevention act • Requires the use of safer devices to protect from sharps injury • Sharp injuries log Safe patient handling and mobility (by ANA) • Outline’s role of employees • Safe patient handling education • Tacking system for injuries (OSHA) Shared Governance Definition: gives healthcare professionals control over their practice and extends their influence into administrative areas Benefits of shared governance • Increases nurse engagement • Improves patient outcomes • Allows hospital admins to optimize efficiency • Increases nurse retention • Promotes quality care Human flourishing – #49- Care Coordination- 7 #57- Healthcare Law- 8 #56- Healthcare Policy- 5 #54- Healthcare Organizations- 7 #39- Leadership- 7 #40- Ethics- 8 #36- Violence-10 #46- Informatics- 8