Final Exam
The Nursing Metaparadigm Concepts:
Person, health, environment, nursing
Theory and evidence-informed knowledge, research, clinical
guidelines
• Provides an essential focus and knowledge basis for professional nursing
The science of nursing
Human interactions and relationships
• Blending the nurse’s ability to adapt to the person’s individual needs through understanding from the person’s perspective through caring, compassion, and therapeutic communication
The art of nursing
Empirical vs. Emancipatory
Empirical: making objective observations
Emancipatory: awareness of social problems and social justice issues
RNAO dimensions of person centered care
- Respect for patients needs
- Coordination/integration of care
- Info & education
- Physical comfort
- Emotional support
- Involvement of family & friends
- Continuity & transition
- Access to care
Involves a deep appreciation of the person’s experience, connecting emotional and sensory experiences.
Aesthetic knowing
Emphasizes self-awareness and the relational aspects
Personal knowing
Most significant determinants of health
Income status and Indigenous identity
Third level of disease prevention, initiated in convalescence stage to prevent progression
Tertiary
Broad, abstract theories providing a general framework (Orem's theory)
Grand theories
Health outcomes of groups of people, and how these outcomes are distributed, influenced by wide range of factors, nursing practice includes knowledge of population, using evidence based approaches, addressing health disparities, disease prevention
Population health
The Implementation Process: 6 Steps
1. Reasses patient
2. Review/revise existing
3. Organize recources
4. Anticipate/prevent complications
5. Identify areas of assistance
6. Implementing skills (cognitive, interpersonal, pyschomotor)
What does LEARNS stand for:
Listen, establish, adopt, reinforce, name, strengthen
The Evaluation Process:
1. Identify criteria and standards (goals)
2. Collecting/evaluating data
3. Interpreting/summarizing findings
4. Document findings
5. Care plan revision
6. Modifying care plan
Implementation involves:
Direct and Indirect interventions
A change in a patient's blood pressure from 180/100mmHg to 130/82mmHg 6 hours after antihypertensive medication is an example of what?
Evaluative measure
Generating solutions is also:
Determining actions to take and planning
Recognizing cues is also:
Getting the information/assessing
Which behavior is the most complex in the psychomotor learning domain?
Origination (creating new movement patterns)
Prioritizing hypotheses is also:
Determining action to take/planning
Which organization standardizes care?
Nursing Interventions Classification (NIC)
CNO Responsibilities:
Entry to practice requirements, practice standards, quality assurance program, enforcing practice and conduct
The purpose of NANDA International, NIC and NOC?
Facilitates matching nursing diagnoses with appropriate interventions and outcomes
Scope of Practice is:
What a profession does and its methods
This legislation regulates all nurses in ON
- Includes Scope of Practice, Entry-to-Practice Competencies, Quality Assurance, Professional Misconduct, Controlled Acts
The Nursing Act 1991
The set of nursing interventions that nurses perform, providing a level of standardization that enchances communication of nursing care across all health care settings and enables comparing of health outcomes
Nursing Interventions Classification (NIC)
Documents guiding decisions and interventions for specific health care problems based on current scientific evidence
Clinical Practice Guidelines and Protocols
When choosing interventions, there are 6 factors the nurse considers:
Nursing diagnosis
Goals/expected outcome
Evidence base
Feasibility
Acceptability to patient
Nurse's competence
A primary source:
Patient
Data that includes patient's decriptions of their health concerns (feelings, symptoms, perceptions)
- Only can come from a patient
Subjective data
The 5 components of the nursing process:
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
Analyzing cues is also:
Making meaning of the information/diagnosis
The RHPA is intended to:
- Protect and serve public interest
- Improve care
- Provide framework for modern care
What organization catergorizes diagnoses into actual, risk, health promotion, wellness
NANDA International
_______ is the term nursing uses to describe
interpersonal communication skills. Through partnership, collaboration, and understanding of the
clients' health situations, nurses find common ground to set
goals.
Relational practice
Components of the nurse-client relationship:
Trust
• Respect
• Professional intimacy
• Empathy
• Power
Important elements of relational practice are
- Nursing presence is the nurse’s availability and openness to partnering with the clients on their health journey.
•Therapeutic communication
•Client-centred care
•Interprofessional collaboration
According to CNO (2018), four standard statements describe what a nurse is accountable for in the therapeutic nurse-client relationship:
• therapeutic communication
• client-centred care
• maintaining boundaries/giving and accepting gifts
• protecting the client from abuse
SOLER:
• S = Sit facing the person
• O = Keep an open posture
• L = Lean toward the person
• E = Initiate and maintain eye contact
• R = Relax
Effective Questioning: Types of Questions:
Open-ended questions – open to interpretation, can’t be answered yes or no
Focused questions – requires more than yes or no answer; place limitations on the topic to be addressed
Closed-ended questions – single answer (yes, no, simple phrase)
A ______ domain describes how to cultivate clear communication, respectful and compassionate care, engage patients in managing their care, and integrate care.
Process
The ______ domains identified include: access to care and
patient-reported outcomes
Outcomes
According to RNAO best practice guidelines (2015) the principles of person and family centred care include
1. Establishing a therapeutic relationship for true
partnership, continuity of care, and shared decision
making
2. Care is organized around, and respectful of, the
person. For a person to be satisfied with health-care
services, care must be organized with and around the
person.
3. Knowing the whole person (holistic care) A person
is not defined by their disease or their illness.
4. Communication, collaboration, and engagement
Person- and Family-Centred Care (Practice Recommendations for Assessment)
Establish, Build, Listen and Seek, Document
Principles of the Canada Health Act (1984)
Public administration: Operate on non-profit basis through public authority
Comprehensiveness: Cover medically necessary services
Universality: Free of discrimination
Portability: Coverage across Canada for insured residents
Accessibility: Reasonable access, regardless of ability to pay
• A key component of Canadian social safety net
• Provides hospital and medical insurance
• Funded by general taxation
Medicare
Foundation of Canada’s health care system
• Provides continuity of care
- Model for improving health that supports essential health services
- Emphasis is on health promotion and disease prevention
Primary Health Care
Primary health care includes:
Primary care and health education, nutrition, maternal and
child health care, family planning, immunizations, and control of locally endemic disease
Four Pillars of Primary Health
Care:
- Teams
• Access
• Information
• Healthy living
Barriers to Primary Health Care
• Individual-level barriers
• Practice-level barriers
• System-level barriers
Five levels of health care:
• Level 1: Health promotion
• Level 2: Disease and injury prevention
• Level 3: Diagnosis and treatment
• Level 4: Rehabilitation
• Level 5: Supportive care
Current major challenges:
- Sustainability
• Political Economy of Health
• Climate Change
• Primary Health Care vs. Primary Care Spending
• Responsive Health Care Planning and Delivery
• Human Health Care Resources
• Aging Canadian Population
• Truth & Reconciliation Commission Calls to Action
Provincial and territorial governments:
• Develop and administer their own health care insurance plans
• Manage, finance, and plan insurable health care services and delivery
• Determine organization/location of hospitals or long-term care facilities; employ health professionals in various
specialties; and determine amount of money dedicated to health care services
• Reimburse physician and hospital costs and rehabilitation and long-term care services
All people (individuals, groups, and communities) are able to reach their full health potential without being disadvantaged by social, economic, or environmental conditions
Health equity
An action or a decision that treats a person or a group badly for reasons such as their race, age or disability.
Discrimination
Includes any unwanted physical or verbal behaviour that offends or humiliates you.
Harassment
What are some inequities and injustices facing Canadians today?
- Homelessness
- Poverty
- Systemic racism
It is the equitable, or fair, distribution of society's benefits, responsibilities and their consequences.
Social Justice
Primary goal focus on health care of individuals, families, and groups Includes:
• Public health nursing
• Home health (community-based) nursing
• Community mental health nursing
• Variety of other specialties
Community Health Nursing Care
Fcuses on education, rehabilitation, support
services, health promotion, and disease prevention.
- It involves multidisciplinary teams and collaboration with other
sectors, as well as with secondary and tertiary care facilities
- Empowerment-based models of community practice
Primary health care
A process by which people, individually, and collectively in
organizations and communities, exercise their ability to effect change to enhance control, quality of life, political effectiveness, and social justice
Empowerment
An approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups.
Population Health
- Also known as Community-Based Nursing
- Involves acute, chronic, and palliative care of individuals and their families that enhances their capacity for self-care and promotes autonomy in decision making.
- Nursing takes place in community settings such as the home, a long-term care facility, school or a clinic.
- Family-centred care
Home Health Nursing
Vulnerable Populations or High Priority Populations
People who live in poverty
• People who are homeless
• People who live in precarious circumstances
• People with chronic conditions and disabilities
• People who engage in stigmatizing risk behaviours
• Indigenous peoples
• New immigrants and refugees
• LGBTQ2
• Minorities
• People with disabilities
This public health policy Identified prerequisites for health: peace, shelter, education, food, income, stable ecosystem, equity, sustainable resources, social justice
Ottawa Charter (WHO, 1986)
3 Strategies to Enhance Health (The Ottawa Charter, WHO, 1986)
1. Advocate
2. Mediate
3. Enable
- Identify need for policy and program development
- Participate in program development, implementation, and evaluation
- Help establish policies to support practice
Nursing activities related to public health policy
A process that requires persons to acknowledge their own
biases when engaging with others, which then provides a place to begin a relationship in an open and honest space.
Cultural Humility
An approach that recognizes the possibility that people may have had previous traumatic experiences in their lives, and that healthcare systems can sometimes re-traumatize people by taking away their control and exerting power over them
Trauma-Informed Care
________ is used to monitor a client’s progress and communicate with other care providers. It also reflects the nursing care that is provided to a client
Documentation
According to CNO, Documentation is important to:
- Determine the care required or provided
• Evaluate professional practice for quality improvement
• Assess nursing interventions and evaluate outcomes
• Facilitate practice reflection
Documentation has many forms:
Paper, electronic, audio or visual
The health record is a _____ document
Legal
Documentation accounts for ______% of a nurse's time:
21.5%
Purpose of Medical Records
• Communication and medical planning
• Legal documentation
• Funding and resource management
• Auditing and monitoring
• Research
• Education
An _____ is a digital version of patient data that is found in
traditional paper records.
EHR
Legal guidelines for documentation include:
- Objective and factual information that is accurate
- Free of errors
- Free of empty phrases or generalized phrases
- No pre-charting (document close to event)
- Only document for yourself
- No erasing and leave initials
- No blank spaces
Guidelines for Quality Documentation and Reporting
• Factual
• Accurate
• Current
• Organized
• Compliant with Standards
Documentation with a story-like format
Narrative
Documentation is organized by patient's problems (Database, problem list, care plan, progree note SOAP)
Problem-orientated
Documentation where each discipline has a different section (nursing, social work)
Source records
Documentation where the philosophy is that a patient meets all standards unless otherwise documented
Charting by Exception
Documentation that incorporates an interdisciplinary approach to documentating patient care
Case management and use of critical pathways
SOAP:
• S: Subjective data ( verbalizations of the patient)
• O: Objective data (that which is measured and observed)
• A: Assessment (diagnosis based on the data)
• P: Plan (what the caregiver plans to do)
SOAPIE:
• S: Subjective ( verbalizations of the patient)
• O: Objective (that which is measured and observed)
• A: Assessment (diagnosis based on the data)
• P: Plan (what the caregiver plans to do)
• I: Intervention (what was done)
• E: Evaluation (effectiveness of interventions)
• SOAPIE aligns with the nursing process (the nurse collects data about a patient’s problems, draws conclusions, develops a plan of care, and then evaluates the outcomes)
PIE Charting includes:
• P: Problem
• I: Intervention
• E: Evaluation
DAR Notes (Problem Oriented Medical Records) includes:
• D: Data (both subjective and objective)
• A: Action (nursing intervention)
• R: Response of the patient (evaluation of effectiveness)
Organization of Traditional Source Record:
Admission sheet
Order sheet
Nurse’s admission assessment
Graphic sheet and flow sheet
Medical history and examination
Medication administration record (MAR)
Progress notes
Health care discipline’s records
Discharge summary
What is an excception in charting by exception?
• Change of condition in the client
• What change happened and what actions that were taken, are important to document
• Incident involving client and/or family
• Fall, altercation, medication error, etc.
• Clinical discrepancy in care provision
Confidentiality of ___________ is the responsibility of all people working in health care.
Personal health information (PHI)
Includes individually identifiable health information such as:
- Demographic data
- Future physical or mental health condition
- Care that identifies the individual)
PHI
Federal legislation that protects personal information, including health information
Personal Information Protection and Electronic Documents Act (PIPEDA)
An arrangement for services by another care provider
Referral
Professional caregiver gives formal advice about the care of a
patient to another caregiver
Consultation
Common Record-Keeping Forms:
• Admission nursing history form
• Flow sheets and graphic records
• Patient summary or Kardex
• Standardized care plans
• Discharge summary forms
An evidence-based tool to aid communication among all staff within the circle of care.
- Structured communication framework that assists teams to share information about a patient’s condition
- Used for quick access to client info
SBAR Communication Tool - Situation, Background, Assessment, Recommendations
Advantages of a Nursing Clinical Information System:
- Easier access to information
- Enhanced quality of documentation
- Reduced errors of omission
- Reduced costs
- Develop common database
- Increase job satisfaction
(I-SBAR-R) technique is also:
Identification-situation-background-assessment-recommendation-read back
What framework enhances the effectiveness of healthcare teams in Canada?
The Canadian Interprofessional Health Collaborative’s National Interprofessional Competency Framework.
What are the four aspects influencing how another person receives your message?
Affinity, immediacy, respect, and control.