Final exam CB 253

adjusting to unusual demands or stressors

giving a greater effort and using greater energy needed in ADLs

a state of changing that occurs automatically as a result of physical, mental, and emotional stresses that cause positive and negative emotions and have physical and mental effects

most common, occurs for short period of time reaction to a real or perceived demand, threat, or pressure eliminate stress response

self inflicted or in regular chaos common among type A personalities taking on unrealistic assignments

perceptual or sustained demand, threat or pressure harmful to health continuous long-term stress, no hope

injury, illness

occupation, relationship, academic

HEALTHY: generating solutions to reduce or eliminate identified stressors action is taken to manage or change situation or circumstance associated with stressor eliminating or reducing harm from stressor

HEALTHY: emphasizes regulation of emotional response maintaining emotional control through self-regulating thinking and behavior no change, but control

HEALTHY: draws on values beliefs, and goals to modify personal interpretation and response conversation with reliable person to find meaning of situation

not addressing the problem ignoring the problem abuse of alcohol, drugs, or bad eating habits

crimean war era founder of modern nursing, hygienic practices

civil war conductor of underground railroad saving 300+ lives volunteered for Union Army to care for African American soldiers founded Harriet Tubman Home for Aged

1819-1892 journalist + poet during civil war volunteered as nurse for union army after visiting his brother in an army hospital wrote poem "The Wound-Dresser"

1845-1926 first black professional nurse US

1865-1940 public health nurse Henry Street Settlement

Henry Street Settlement

1881 started red cross

1st nursing professor at Columbia Teacher's College moved nursing education into universities

founder of Frontier Nursing Service

1: optimal functioning of the human being, person, or patient 2: how people interact w/environment 3: healing of illness and health promotion 4: nursing role

an overarching set of concepts broad conceptual boundaries of a discipline

roles played by the nurse and the interpersonal process between nurse and patient

assisting individuals to gain independence in relation to performance of activities contributing to health or its recovery

assist w attaining and maintaining maximum wellness focused on patients response to stressors and strengthening their lines of defense

based on caring, w nurses dedicated to health and healing TRANSPERSONAL CARING

no experience, rigid adherence to rules or plans little situational perception, no discretionary judgement, beginning of analytical decision making

more sophisticated rules beginning situational perception

working 2-3 years, more analytical thinking, lacks speed and flexibility sees action at least partly in terms of longer term goals, conscious deliberate planning

experiences to make decisions, situations seen holistically and most important perceives deviations from normal pattern decision making less labored, uses maxims for guidance meaning of which varies according to situation

no longer relies on rules, guidelines or maxims, intuitive grasp of situations based on deep tacit understanding, analytic approaches used only in novel situations or when problems occur, visions of what is possible

provides the scope of practice defined by each state or jurisdiction and set forth the legal limits of nursing practice

the Board of Nursing

regulates and protects the public from practitioners who are a risk to the health, safety, and welfare of the citizens within state board jurisdiction

leader, manager, researcher, collaborator, educator, advocate, delegator, change agent, care provider

assess health conditions, function independently, ADPIE

contributing to assessment of health status of individuals or groups, function dependently under RN or physician always

crime that has bearing on one's ability to practice competently

a compilation of ethical rules designed to guide the nurse in making the correct decision in difficult patient-care situations

the RN collects comprehensive data important to the client health

RN analyzes assessment data to determine diagnosis or issues

RN identifies expected outcomes for a plan individualized to patient or situation

RN develops plan that prescribes strategies and alternatives to attain expected outcomes

RN implements the identified plan a- coordination of care b- teaching health promotion c- consultation d- prescriptive authority and treatment

RN evaluates progress toward the attainment of outcomes

RN practices ethically

RN attains knowledge and competency that reflects nursing practice

RN integrates evidence and research into practice

RN contributes to quality nursing practice

RN communicates effectively in all areas of practice

RN demonstrates leadership in professional practice setting and profession

RN collaborates w health care consumer, family and others in the conduct of nursing practice

RN evaluates her or his own nursing practice in relation to professional practice standards and guidelines relevant statues rules and regulations

RN uses resources to plan and provide nursing services that are safe effective and financially responsible

RN practices in an environmentally safe and healthy manner

nurse, LPN, PCA, CAN, APRN physician, primary care, specialists, surgeons PATIENT/FAMILY is the center PT, RT, recreational therapy, RD, CST chaplaincy, social work, psychology, psychiatry

when multiple health workers from different professional backgrounds, work together w patients, families, care-givers, and communities to address local health care needed to deliver highest quality care

concerns about quality of US healthcare system 48k-98k Americans die each year due to medical errors lack of teamwork, collaboration, and communication costly healthcare yet poor outcomes

shared goals, clear roles, effective communication, measurable processes and outcomes, mutual trust

values and ethics, roles, responsibilities, IPC, and teams/teamwork

ability to apply higher order cognitive skills and disposition to be deliberate about thinking (open minded or intellectually honest) leads to action that is logical and appropriate

ability to focus and filter clinical data to recognize what is most and least important so nurse can identify if actual problem is present

combines critical thinking, clinical reasoning, and repetitive decision making skills of the nurse

easily understood

true and correct way

providing sufficient detail

focusing on facts and ideas directly related to topic

beneath surface of topic or problem to identify and manage related complexities

considering a topic, problem, or issue from every relevant view point

using mutually supportive and sensible combination of thoughts and facts to form a conclusion

concentrating on most important information

thinking or acting in accord w reason and without bias

likely conclusion probability reasonable confidence making inference based on widely accepted facts or premises

certainty guaranteed conclusion proof making an inference based on observation often sample

discussions w colleagues emotional intelligence audible verbalization of thoughts literature review intentional application of knowledge concept maps simulation role playing written work

make a plan, make a commitment

both loved ones had poor health outcomes, one died, one left with serious health issues. cofounded and is past president of Parents of Infants and Children with Kernicterus

lack of time, hierarchy, defensiveness, conflict, fatigue, inconsistency, team membership, workload, lack of role clarity, distractions

leadership, communication, situation monitoring, mutual support

knowledge, attitudes, performance

hold shared mental models, have clear roles/responsibilities, have clear valued and shared visions and optimize resources, strong team leadership, engage in regular discipline of feedback, develop strong sense of collective trust and confidence, create mechanisms to cooperate and coordinate, and manage and optimize performance outcomes

2 or more people who interact dynamically, interdependently, and adaptively towards a common valued goal, have specific roles or functions, and have a time-limited membership

include patients in bedside rounds, conduct handoffs at bedside, provide communication tools for patient so they can communicate with the care team, involve patients in key committees, actively enlist patient participation

listen to patients and families, assess patients preferences regarding family involvement, ask patients about their concerns, speak to them in LAY TERMS, allow time for patients and families to ask questions, ask for their feedback, give them access to relevant info, encourage patients to proactively participate in patients care

provide accurate patient info, comply w prescribed plan of care, ask questions/voice concerns regarding plan of care, monitor report changes in patients conditions, manage family members, follow instructions of clinical team

patient, core team, contingency team, coordinating team, ancillary and support services, administration

core team: group of care providers who work interdependently to manage a set of assigned patients from pint of assessment to disposition contingency team: time limited team formed for emergent events coordinating team: compromising the work area members who are responsible for managing the operational environments supporting core team ancillary services: provide direct task specific time limited care to patients support services: provide indirect service focused tasks which help to facilitate the optimal health care experience for patients/families administration: establish/ communicate vision, develop policies and set expectations for staff related to teamwork and define culture of organization

anything that causes death or severe harm to a patients in a healthcare setting, ineffective communication caused 66% of sentinel events

complete: communicate all relevant info clear: convey info that's plainly understood brief: communicate info in concise matter timely: offer and request info in an appropriate timeframe, verify authenticity, validate, or acknowledge info

language barrier, distractions, physical proximity, personalities, workload, varying communication styles, conflict, lack of info verification, shift change

Introduction Situation Background Assessment Recommendation Readback

I PASS THE BATON

ANTICipate

I PASS

SHARQ

designated: person assigned to lead organize a team, establish clear goals, facilitate open communication and teamwork among members situational: any team members who has skills to manage situation at hand

define, assign, share, monitor, and modify plans, review team performance, establish "rules of engagement" manage + allocate resources effectively, provide feedback regarding assigned responsibilities + progress toward the goal, facilitate info sharing, encourage team members to assist each other, facilitate conflict resolution, model effective teamwork

time (enough to complete tasks and activities), people (necessary knowledge and skills), equipment (working and available), info (necessary info collected and reviewed)

briefs: sharing plan beforehand (between clients and agencies) huddle: "touch base" meetings (start of a work day before shift) debrief: informal info exchanged during feedback session, recounts key events what went right what went wrong how to fix for next time (after critical events)

facilitate conflict resolution to avoid compromising patient safety + quality of care, don't allow interpersonal or irrelevant issues to negatively affect team, helps team members master conflict resolution technique

situation monitoring (individual skill) situation awareness (individual outcome) shared mental model (team outcome)

-Status of the patient (history, vital signs, meds, exam, care plan, mental state) -Team members (fatigue, workload, task performance, skill & stress level) -Environment (facility info, admin. info, HR, triage acuity, equipment) -Progress toward goal (huddle, status of patient, goal of team, task/actions need completed, plan still appropriate)

I: illness M: med (CAN'T WORK ON NARCOTICS) S: stress A: alcohol and drugs F: fatigue E: eating & eliminating (bathroom to prevent UTI) Team safety

failure to: share info w team, request info from others, direct info to specific team members, include patient or fam in communication, utilize resources fully, maintain documentation, know and understand where to focus attention, know and understand plan, inform team members of plan changes