NR 222 Exam 2 Study Guide
1. Chamberlain care model
• We are not just another College of Nursing-we are distinctly Chamberlain College of Nursing. Our
... [Show More] distinction is rooted in our culture of care-Chamberlain Care-that permeates every aspect of the College and is embedded in the mindful actions of each and every one of us. Chamberlain Care is our way of being: caring for ourselves informs and sustains caring relationships with our colleagues, students, patients, and the community we touch.
2. Healthy people 2020 goals (4 goals)
• Attain high quality, longer lives free of preventable diseases, disability, injury, and premature death.
• Achieve health equity, eliminate disparities and improve the health of all groups.
• Create social and physical environments that promote good heath for all.
• Promote quality of life, healthy development, and healthy behaviors across all life stages.
3. HP 2020 LHI
• LHI’s alters us to evidence of problem areas
• Provide us with goal outcomes based on scientific evidence to help improve those outcomes
• Drive many public health projects today and influence organization in both preventative and restorative efforts
• Services include:
Leading Health indicator
Access to health service
Affordable care act
Improved access to health care insurance
Centers for Medicare and Medicaid
• Examples of LHI
Tobacco
Adults who smoke currently
Adolescents who have smoked within 30 days
Mental health and substance abuse
Alcohol and/or drug use by adolescents
Binge drinking by adults
Major depression in adolescents
Suicide
Environmental quality
Air quality index > 100
Children exposed to second hand smoke
4. Steps of the nursing process ADOPIE
• Assessment- gather info about patient condition
Collect and analyze data
Types of assessment:
o the patient-centered interview during a nursing health history.
o a physical examination.
o the periodic assessments you make during rounding or administering care.
• Diagnose- identify the patient’s problem
• Outcome- set goals
• Plan- identify appropriate nursing actions to reach goal
• Implementation- perform the nursing actions or plan into action; includes teaching in this step.
• Evaluate- determine if goals and outcomes have been achieved.
5. How to plan teaching for low literacy levels
• Determine goals and expected outcomes that guide the choice of teaching strategies and approaches with a patient:
o Set priorities.
o Select timing to teach.
o Organize the teaching materials.
o Use teamwork and collaboration.
6. What is important to asses regarding patient’s health needs (communication)
• See through the patient’s eyes.
o Teaching is patient-centered.
• Assess the patient’s learning needs.
o Information or skills needed to perform self-care and to understand the implications of a health problem.
o Patient experiences that influence the need to learn.
o Information that family caregivers need to support patient needs.
• Motivation to learn
• Ability to learn
• Teaching environment
• Resources for learning
• Health literacy: the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health.
• Health literacy includes patients’ reading and mathematics skills, comprehension, and decision-making and functioning skills regarding health care.
7. Type of space/zone for nurse teaching patient
• Social (9-12 ft)- Knocking to enter
• Personal (18 inches- 4ft)- moving closer to the patient
• Intimate (up to 18 inches)- when taking vitals/assessment
• Public (12 feet and over)- speaking from far distance. Interaction with an audience. Nurses can speak about health-related topics. Effective communication can increase audiences knowledge about important health issues.
• Intrapersonal- Occurs WITHIN an INDIVIDUAL EX: communication with yourself, making a to-do list counts, journaling, writing in a calendar, or even psyching yourself up to do something. We use it to develop self-awareness and a positive self-concept that will enhance self-expression. Can improve self-esteem and healthy by replacing negative thoughts with positive.
• Interpersonal- One-to-one interaction BETWEEN two people; Level most frequently used in nursing. It is important to validate meanings or mutually negotiate it. Results in exchange of ideas, problem solving, expression of feelings, decision making, goal accomplishments, team building, and personal growth.
• Small group- Interaction that occurs when a small number of persons meet together.
• Transpersonal- Interaction that occurs within a person's spiritual domain. Nurses have a responsibility to assess client's spiritual needs and intervene to meet those needs. EX: prayer, meditation, and guided reflection.
8. Violence- intimate partner HP 2020- those most at risk.
• Each year, women experience about 4.8 million intimate partner-related physical assaults and rapes.
• Men are the victims of about 2.9 million intimate partner-related physical assaults.
• A history of exposure to adverse experiences in childhood, including exposure to violence and maltreatment, is associated with health risk behaviors such as smoking, alcohol and drug use, and risky sexual behavior, as well as obesity, diabetes, sexually transmitted diseases, attempted suicide, and other health problems
9. Types of learner-3
• Kinesthetic- Is a learning style in which learning takes place by the student carrying out a physical activity, rather than listening to a lecture or watching a demonstration.
o 3 ways to study:
o 1. Keep your desk of distracting objects.
o 2. Cover the page you're not reading.
o 3. Gets plenty of sleep.
• Visual- Is a teaching and learning style in which ideas, concepts, data, and other information are associated with images and techniques.
o 3 ways to study:
o 1. Take notes, make picture, graphs, and charts. Use FlashCards and highlight key details.
o 2. Sit close to a teacher so that you can watch his/her face and gestures.
o 3. Takes notes or make lists as you listen to directions.
• Auditory- learns through listening and speaking. This type of learner needs to hear information to be able to process and comprehend as well as have the opportunity to reinforce that information orally.
o 3 ways to study:
o 1. Read your work out loud. Summarize what you read on tape.
o 2. Say words inside your head silently.
o 3. Brainstorm ideas with others. From study groups.
10. Maslow’s hierarchy of needs
• This model is used by nurse to understand the interrelationships of basic human needs
• The higher order needs can only be met when the ones beneath have been met satisfactorily
• Physiological -1
Airway
Breathing
Circulation
Nutrition
Electrolytes
elimination
• Safety and security-2
Safety measures
Education for the patient
Things you should be monitoring for when they go home
• Love and belonging-3
Friendships
Romantic attachments
Family
Social groups
Community groups
Churches and religious organizations
• Self-esteem-4
People need to sense that they are valued and by others and feel that they are contributing to the world.
Participation in professional activities
academic accomplishments
athletic or team participation
personal hobbies can all play a role in fulfilling the esteem needs.
• Self-actualization- 5
This level of need pertains to what a person’s full potential is and realizing that potential. “what a man can be, he must be” is the basis of the perceived need for self-actualization. This as the desire to become everything that one can become.
11. Communication styles verbal/nonverbal
• Verbal:
o Use of spoken or written words. Aspects:
o Vocabulary- Communication is unsuccessful if sender and receiver cannot translate each other's words and phrases. Limiting of medical jargon in conversations with other health care team members will improve communication. Children have limited vocabulary, Teenagers use unique words and slang.
o Denotative- is the dictionary meaning. A baseball= A baseball.
o Connotative- Connotative meaning is the interpretation of the words meaning influenced by thoughts, feelings, or ideas people have about the word. Code= Emergency.
o Pacing- Conversation is more successful at an appropriate speed or pace. Long pauses and rapid shifts to another subject give the impression that the nurse is hiding the truth.
o Intonation- Tone of voice. Be aware of voice tone to avoid sending unintended messages. Tells nurses emotional state + energy level. Patronizing tone breaks client relationship. Can reflect a caring or disinterested attitude.
o Clarity and brevity- Effective communication is simple, brief, and direct. fewer words equals less confusion. Repeat important phrases and give examples. Phrases such as "you know" or "ok" detract from clarity.
o Timing and Relevance- Timing is critical. You do not begin routine teaching when a client is in extreme pain. When a patient is going into surgery you should not start describing a diet plan. Pick appropriate time.
o Words are symbols for ideas
o Includes sign language, braille, touch language
o Communication with language is critical ability
o Challenge: language differences
o Functions: to inform, to trigger response, to describe
• Nonverbal
o Personal appearance
o Posture and gait
o Facial expressions
o Eye contact
o Gestures
o Sounds
o Territoriality and personal space
o Particularly vulnerable to misunderstanding
o Culturally and situationally bound
o Great power to transmit info thoughts, feelings, etc.
o Nonverbal messages from both patient and nurse
12. Open-ended statements (examples)
• Where have you looked already?
• What kind of information about your care are you looking for?
• What would you like to know about the hospital?
• When you said you are hurt, what do you mean?
• What do you mean by being frustrated?
• How might you use the information I have given you?
• What are you trying to understand?
13. Polypharmacy
• refers to three or more medications prescribed at the same time. This may include an attempt to treat side effects of other drugs.
• Since polypharmacy is a consequence of having several underlying medical conditions, it is much more common in elderly patients.
• Polypharmacy can become problematic when multiple healthcare providers work independently of each other and prescribe patients too many medications
14. What are components of the affective domain
• Recognition of values, relationships, attitudes
• Determining Outcomes
Outcomes driven by public health, societal, and participant goals
Program goals: long-range expected outcomes
Learning goals are established jointly
Identify desired health behavior or status
Learning objectives
o Steps to be taken by learner
o Should be behavioral
o Use action verb
o State what to be done, under what conditions, at what level
15. Strategies to promote health literacy in an effective teaching environment
• Health literacy- degree to which individual have capacity to obtain (understand) health information to make appropriate decisions
• Nurses have key role in promoting health literacy
• Majority of persons have deficient health literacy
• Goals of health education
Help individuals, families, and communities achieve optimal health (via their own actions)
Two objectives of health education/counseling
o Change health behaviors
o Encourage positive, informed changes in lifestyle
o Empower the individual
Improve health status
o Prevent acute and chronic disease
o Decrease disability
o Enhance wellness
16. Nurses’ actions to decrease bias and be effective in culturally competent care
• Cultural Awareness
Bias: a predisposition to see people or things in a certain light, either positive or negative.
Becoming more self-aware of your biases and attitudes about human behavior is the first step in providing patient-centered care
• Knowledge World views
World view
o Emic (insider perspective)
o Etic (outsider perspective)
Avoid stereotyping
Treat the individual
See every patient encounter as cross-cultural
Iceberg analogy
o Most aspects of a person’s world view are hidden
Conduct a cultural assessment
• Culture assessment
Cultural assessment model
o The goal of a cultural assessment is to obtain accurate information from a patient that allows you to formulate a mutually acceptable and culturally relevant plan of care for each health problem of a patient.
Open-ended, focused, and contrasted questions
o You need to assess and interpret a patient’s perspective during your assessment. Use open-ended, focused, and contrasted questions.
Explanatory model
o One effective approach to assessment is to ask questions that will help you understand a patient’s explanatory model—his or her views about health and illness and its treatment.
o There are five questions in most explanatory models:
etiology,
time and mode of onset of symptoms,
pathophysiology,
course of illness and treatment for an illness episode
Trust
o Cultural assessment is intrusive and may take more time to conduct because it requires building a trusting relationship between participants.
17. Health risk factors common for each cultural group.
• Asian America/Pacific islanders
o Health concerns and care issues
Hesitancy to seek early diagnosis/screening
Higher rate of tuberculosis
Mental health problems due to adjustment issues
Lower rate of obesity, hypertension
Risk factors
o Barriers to care
Poverty
Stress in intergenerational relationships
Cultural norms that prevent health care seeking
Loss of social networks
Poor access to services
• Native American
o Health concerns and care issues
Linked to social and economic conditions
Smoking, substance abuse
Deaths: unintentional injuries, cirrhosis, homicide, suicide, pneumonia, diabetes
Risk factors
o Barriers to care
Difficult access to care
Underserved population
• African American
o Health concerns and care issues
Higher cancer deaths
HIV
Hypertension
Obesity
Mental health concerns
Risk factors
o Barriers to care
Poverty
Lack of health insurance
Inadequate or unsafe environments
• Arab
o Health concerns and care issues
Adult-Onset Diabetes Mellitus
Coronary artery disease
Role of acculturation
Mental health
Teenage smoking
Risk factors
o Barriers to care
Religious belief and practices
Cultural norms/modesty
Gender issues regarding providers
Communication difficulty
Folk remedies
Lack of culturally competent providers
• Latino/Hispanic
Health concerns and care issues
o Higher incidence of
o Stomach cancer
o Diabetes mellitus
o Cardiovascular disease
o HIV
Risk factors
o Barriers to care
Highest uninsured rate of any U.S. racial/ethnic group
Use/receive less preventative health care
Lack of interpreter services in health care
Lack culturally appropriate health care services
Reliance on folk systems of healing
18. Values belief pattern
• Value
A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior
• Value clarification
Ethical dilemmas almost always occur in the presence of conflicting values
To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinions
19. Domains of learning
• Three domains of learning:
1. Cognitive: new facts or concepts, building on knowledge
2. Psychomotor: developing physical skills
3. Affective: recognition of values, beliefs, relationships, attitudes
20. Piaget cognitive theory and stages/examples
• Sensorimotor (birth-2 yrs.)- Reflexes begin to turn into simple reflex to a symbolic process. EX: my son touched the radiator and got burned. He’ll never do that again.
• Preoperational (2 to 7 years)- Marked by the use of symbols to represent objects. Development of egocentric thinking. EX: my daughter asked an obese lady if she had a baby in her stomach.
• Concrete operations (7 to 11 years)- Child uses mental operations to solve problems and to reason. Mastering facts EX: my son is learning math and is getting 100s on his test. He is so smart.
• Formal operations (11 years to adulthood)- logical thought and abstract concepts. EX: my daughter is on the debate team at school. We go to interschool now.
21. Freud id/ego/superego
• Id- A reservoir of unconscious psychic energy that constantly strives to satisfy basic drives to survive, reproduce, and aggress. Id operates on the pleasure principle. EX: Michael saw a $5 bill fall out of Nick's backpack as he pulled his books out of his locker. As Nick walked away, Michael bent over, picked up the money, and slipped it into his pocket, glancing around to make sure no one was looking.
• Ego- young child learns to cope with the real world. (conscious mind) operates on the reality principle. EX: Even though Michael needed money, he decided not to steal the money from the cash register because he didn't want to get in trouble.
• Superego- a voice of conscience that forces the ego to consider not only the real but the ideal. its sole focus is on how one ought to behave. develops as we internalize the morals and values of parents and culture, what is right and wrong. strives for perfection, judges our actions which produce pride or guilt. EX: When Michael saw the $5 bill lying on the floor with no one around it, he turned it into the school office in case anyone came looking for it. He wouldn't want to lose $5 and hoped that whoever had lost it would ask about it in the office.
22. ISBAR
• I- Introduction; Identify yourself, your unit, the patient's name and room number.
If calling another M.D. or staff member: identify patient's primary M.D.
• S- Situation; State the problem. It's a to-the-point punchline to get the attention of the receiver. when it started and how severe it is.
• B- Background; Patient's admitting diagnosis and date of admission.
Any clinical information related to current problem: mental status, VS, meds, IV fluids, lab results, allergies, code status.
Give what is pertinent to the call-not complete history.
• A- Assessment; An assessment of the situation is made:
-What you think is going on with the patient
-What you think the problem is
• R- Request/Recommendation; What's your recommendation for solving the situation?
What do you want/need from the M.D.
This is the step most nurses are least comfortable with. 'I suggest/request that you...'
Are tests needed?
23. Phases of nurse-patient relationship
• 1. Pre-interaction phase: occurs before meeting the patient EX: Obtaining available information about the client from his or her charts, significant others or other health team members. From this information the initial assessment is begun. Also, the nurse plans how she is going to interact with the patient, what she is going to achieve from this interaction and how she is going to help the patient.
• 2. Orientation phase: when the nurse and the patient meet and get to know each other. EX: Nurse introduce herself to the patient, build trust and rapport by demonstrating acceptance, establishing a therapeutic environment ensuring safety and privacy
• 3. Working phase: when the nurse and the patient work together to solve problems and accomplish goals.
• 4. Termination phase: occurs at the end of a relationship. EX: The nurse discusses the termination phase with the client encourages to identify the progress that the client has made and explores the necessity of any referral that maybe beneficial to the patient.
24. Elements of communication (circular transactional model)
• Message- content of the communication
• Sender- person who desires to deliver a message to another person or group of people
• Referent- cues that initiate communication
• Interpersonal variables- factors within a person that influence communication
• Environment- the setting of the interaction
• Receiver- person or persons who receive the encoded message sent by the sender
• Channels- means of sending and receiving messages
• Feedback- how the receiver indicates they understood the message
25. Non-therapeutic communication techniques
• Asking personal questions
• Giving personal opinions
• Changing the subject
• Automatic responses
• False reassurance
• Sympathy
• Asking for explanations
• Approval or disapproval
• Defensive responses
• Passive or aggressive response
• Arguing
26. Therapeutic communication techniques
• Therapeutic communication techniques are specific responses that encourage the expression of feelings and ideas and convey acceptance and respect.
• Sharing observations
• Sharing empathy
• Sharing hope
• Sharing humor
• Sharing feelings
• Using touch
• Using silence
• Providing information
• Clarifying
• Focusing
• Paraphrasing
• Validation
• Asking relevant questions
• Summarizing
• Self-disclosure
• Confrontation
27. Informed consent
• Ensuring that a person has all necessary info to formulate autonomous decisions
• Must be competent to make decision
• Proxy decision-making- need someone to make decision for them
o Examples: children, person with dementia or mental impairment, prisoners
o Decisions must account for a likely individual preference and probably goals/values
28. Moral Development
• Preconventional- punishment vs reward
• Conventional- approval vs. disapproval
• Postconventional- achieving justice, establishing personal moral standards
29. Speak up initiatives
• TJC’s Speak Up Tips
• Speak up if you have questions or concerns.
• Pay attention to the care you get.
• Educate yourself about your illness.
• Ask a trusted family member or friend to be your advocate.
• Know which medicines you take and why.
• Use a health care organization that has been carefully evaluated.
• Participate in all decisions about your treatment.
30. Empathy/sympathy
• Empathy-understanding or acceptance of other feelings
• Sympathy- concern, sorrow or pity felt for another
31. Erikson’s stages
• Stage 1: trust vs mistrust (birth-1 yr.) infancy. EX: feeding, being comfort, teething, sleeping
• Stage 2: autonomy vs shame and doubt (1-3 yrs.) toddler. EX: bodily functions, toilet training, muscular control, walking
• Stage 3: initiative vs guilt (3-6 yrs.) preschool. EX: exploration and discovery, adventure and play
• Stage 4: industry vs inferiority (6-11 yrs.) school-age. EX: achievement and accomplishment
• Stage 5: identity vs role confusion (puberty) adolescence. EX: resolving identity and direction, becoming a grown up
• Stage 6: intimacy vs isolation (young adult) EX: work and social life, intimate relationships
• Stage 7: generative vs self-absorption & stagnation (middle age) EX: giving back, helping, contributing
• Stage 8: integrity vs despair (old age) EX: meaning and purpose, life achievements
32. Ways to reduce barriers in learning and teaching/how to plan for low literacy levels; what is important to assess regarding patient health needs.
• Determine learner characteristics and learn needs (assess)
o Age, developmental stage, level of education
o Health beliefs
o Motivation, readiness to learn
o Health risks
o Current knowledge and skills
o Barriers and facilitators to learning
• Teaching plan
o Time, available resources, adequate participants
o Desired behavior changes for health promotion
o Individual is an active participant
o Specify actions or abilities desired during or at end of program.
• Barriers of effective communication
o Anxiety: Alters perception, distorts reality
o Attitudes: Bias/stereotypes- limits ability to relate
o Gaps between the nurse and individual: Sex, age, ethnicity, language
o Resistance: Behavior to reduce anxiety, GOAL- Identify interpret, and understand behavior.
o Transference /countertransference: Reacting to another as if the person is someone from the past. GOAL- understands feelings/thoughts; remove distorted reality.
o Sensory barriers: (individual with limitations) Use other senses; obtain specialized assistance.
o Failure to address concerns/needs: correct source of failure such as inadequate assessment
o Setting: Control/alter disturbing environmental factors.
33. Teaching strategies for low health literacy learners
• Establish a trusting relationship.
• Invite a second person to attend the teaching session, if appropriate.
• Discuss with the person what he or she can and want to do.
• Limit information to essentials for achieving desired behaviors. Be realistic.
• Plan what to say and organize information with the three most important points. (Frame the message first.)
• Slow down!
• Use common words consistently — no medical jargon.
• Define terms.
• Make instructions concrete/specific and vivid rather than general.
• Teach one step at a time.
• Break down complex instructions.
• Make time for the patient to tell his/her story and express feelings.
• Use a variety of teaching methods and tools.
• Use techniques of tailoring and cuing.
• Verify patient understanding by using teach-back technique and problem-solving situations.
• Use praise and rewards.
34. Options for health care services for older adults who can no longer take care of self at home.
• Private homes
• Apartments
• Retirement communities
• Adult day care centers
• Assisted living facilities
• Nursing centers
35. Healthy people 2020 goal Older adults
• Healthy people 2020
o increase the number of older adults with one or more chronic conditions who report confidence in maintaining their conditions.
o Reduce the proportion of older adults who have moderate-to-severe functional limitations.
o Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-term physical activities
36. Signs in teenager of possible related substance abuse.
• Mood changes
• Bad grades
• Loss of interest in activities
• Poor hygiene
• Secretive behavior
37. Behavior of adolescent that may be risk for self-harm.
• Poor school performance
• Lack of interest in things that were of interest to the adolescent in the past
• Social isolation
• Disturbances in sleep or appetite
• Expression of suicidal thoughts
38. Teaching strategies for each developmental stage (all 8)
• Toddler (preoperational stage, symbolic thought)
o Play imperative----learn by repletion
o Picture books
o Singing songs
• Preschool (preoperational stage, symbolic thought)
o Promote early literacy (books, storytelling)
o Create a playful environment
o Teach through observation
o Creativity and art
o Teach alphabet with animal images
o Give natural examples
• School-age (concrete operational)
o Teaching should be interesting and meaningful
o Use concrete materials
o Games
• Adolescence (formal operational, abstract concepts)
o Interact with them
o Break down objectives
o Addition of emotion can help them remember
o Practice/rehearsal
o Visual
o Analogy
o Hands on
• Young adult/middle adult (formal operational)
o Keep relevant
o Integrate emotion into lesson
o Encourage exploration
o Always offer feedback
o Motivate
• Older adults (formal operational)
o More than words
o Learn at slower rate
o Maintain a positive attitude
o Identify and try to accommodate any disability that may affect the learning process.
o Stop teaching if the patient appears tired or stressed
o Break each topic into small parts. Repeat sessions when necessary. Give pertinent, positive feedback. [Show Less]