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Nursing and Patient-Centered Care: Age Ranges, Competencies, Disparities, and Transitions, Exams of Nursing

The University of Edinburgh (Edin)Nursing

Various aspects of adult health nursing, including patient age ranges, nursing competencies for quality care, patient-centered care for special populations, and care transitions. It also touches upon healthcare disparities and integrative therapies.

Typology: Exams

2023/2024

Available from 03/18/2024

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Adult Health Ch 1: Overview of Professional
Nursing Concepts for Medical-Surgical Nursing
2024 FINAL EXAM PREDICTOR
What is the range of ages for patients in adult health nursing? -SOLUTION
18>
Where is medical-surgical nursing practiced? -SOLUTION - Acute care
hospitals
- Skilled nursing facilities
- Ambulatory care settings
- patient's home
What are some of the roles of nurses in adult health nursing? -SOLUTION
- Care coordinator
- Transition manager
- Caregiver
- Patient educator
- Leader
- Patient & family advocate
What does KSA stand for? -SOLUTION - Knowledge
- Skills
- Attitudes
(these are the attributes nurses must have)
What are the six nursing competencies identified by the QSEN for health
care professionals to ensure patient safety and quality care? -SOLUTION -
Provide PATIENT-CENTERED CARE
- COLLABORATE with the interprofessional health care team
- Implement EVIDENCE-BASED PRACTICE
- Use QUALITY IMPROVEMENT in patient care
- Use INFORMATICS in patient care
- SAFETY
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Adult Health Ch 1: Overview of Professional

Nursing Concepts for Medical-Surgical Nursing

2024 FINAL EXAM PREDICTOR

What is the range of ages for patients in adult health nursing? -SOLUTION 18> Where is medical-surgical nursing practiced? -SOLUTION - Acute care hospitals

  • Skilled nursing facilities
  • Ambulatory care settings
  • patient's home What are some of the roles of nurses in adult health nursing? -SOLUTION
  • Care coordinator
  • Transition manager
  • Caregiver
  • Patient educator
  • Leader
  • Patient & family advocate What does KSA stand for? -SOLUTION - Knowledge
  • Skills
  • Attitudes (these are the attributes nurses must have) What are the six nursing competencies identified by the QSEN for health care professionals to ensure patient safety and quality care? -SOLUTION - Provide PATIENT-CENTERED CARE
  • COLLABORATE with the interprofessional health care team
  • Implement EVIDENCE-BASED PRACTICE
  • Use QUALITY IMPROVEMENT in patient care
  • Use INFORMATICS in patient care
  • SAFETY

In addition to the six QSEN competency concepts, what are the four professional nursing concepts? -SOLUTION - Clinical judgment

  • Systems thinking
  • Ethics
  • Health care disparities What is patient-centered care defined as? -SOLUTION The patient or designee is the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs What is family-centered care? -SOLUTION Emphasizes the importance of including the patient's support system as part of interprofessional collaboration What are health care disparities? -SOLUTION Differences in patient access to or availability of appropriate health care services What is essential to ensure a wholistic or "whole person" approach to care? -SOLUTION Showing respect and advocating for the patient AND family's preferences and needs What are some patient-centered care attributes? -SOLUTION - RESPECT for patient's values, preferences, and expressed needs
  • Coordination and integration of care
  • Information, communication, and education
  • PHYSICAL comfort
  • EMOTIONAL support and alleviation of fear and anxiety
  • Involvement of family and friends
  • Transition and continuity
  • Access to care What are some special considered populations that require patient- centered care? -SOLUTION - Older adults
  • Gender health
  • Veterans health
  • Cultural/spiritual
  • Genetic/genomic

For what purpose are care transitions essential? -SOLUTION To prevent adverse events and hospital readmissions What is a care transition? -SOLUTION Involves actions designed to ensure safe, effective coordination and continuity of care as patients experience a change in HEALTH status, primary health care provider (PCP), or SETTING What are some recommended components by the Joint Commission for effective patient-centered care coordination and transition management? - SOLUTION - Understandable DISCHARGE INSTRUCTIONS for the patient and family

  • Explanation of SELF-CARE activities
  • Ongoing or EMERGENCY CARE information
  • List of community and outpatient (ambulatory care) RESOURCES and REFERRALS
  • Knowledge of the patient's LANGUAGE, CULTURE, and HEALTH LITERACY
  • MEDICATION RECONCILIATION What is medication reconciliation? -SOLUTION A formal evaluative process in which the patient's actual current medications are compared with his or her medications at time of ADMISSION, TRANSFER, or DISCHARGE to identify and resolve discrepancies What information is used to reconcile medications? -SOLUTION - Drug name
  • Dose
  • Frequency
  • Route
  • Purpose (This comparison addresses duplications, omissions, and interactions and the need to continue current medications) What are the six steps for improving the care transition or discharge process? -SOLUTION - Educate and coach patients and their caregivers
  • Use TRANSITION COACHES, if available, to improve care coordination and transition management
  • FOLLOW UP with postdischarge visits or phone calls
  • Improve COMMUNICATION HANDOFFS from hospitals to ambulatory care or home care settings
  • Identify high-risk patients for READMISSION on the basis of AGE (older than 80), number of COMORBIDITIES (>=3), number of PRESCRIPTION drugs (>=5), and difficulty performing at least 1 activity of daily living (ADL)
  • Address patient caregiver needs to prevent CAREGIVER ROLE STRAIN What is safety? -SOLUTION The ability to keep the patient and staff free from HARM and minimize ERRORS in care T or F: Patient safety is the priority over the safety of members of the staff and interprofessional team -SOLUTION False, safety for members of the staff and interprofessional team is equally important What do patient harm and errors caused by nurses generally occur as a result of? -SOLUTION - Lack of clear or adequate COMMUNICATION among patient, family, and members of the interprofessional health care team
  • Lack of ATTENTIVENESS and PATIENT MONITORING
  • Lack of CLINICAL JUDGMENT
  • INADEQUATE MEASURES to prevent health complications
  • Errors in MEDICATION ADMINISTRATION
  • Errors in INTERPRETING authorized provider prescription
  • Lack of professional ACCOUNTABILITY and patient ADVOCACY
  • Inability to carry out INTERVENTIONS in an appropriate and timely manner
  • Lack of mandatory REPORTING What is the major priority for professional nurses? -SOLUTION Patient and staff safety What are some ways that best safety practices reduce error and harm through? -SOLUTION - Established protocols
  • Memory checklists
  • Systems such as bar-code medication administration What are the three nursing safety priorities? -SOLUTION - Critical rescue (emphasizes the need for action for potential or actual life-threatening problems)
  • Conducting IP patient care rounds Who does the interprofessional health care team include? -SOLUTION - Patient
  • Family
  • Primary health care providers
  • Nurses
  • Assistive personnel
  • Other health care professionals and their assistants What are the four major Interprofessional Education Collaborative (IPEC) competencies? -SOLUTION - Values/Ethics for Interprofessional Practice: work with individuals of OTHER PROFESSIONS to maintain a climate of mutual respect and shared values
  • Role-Responsibilities: Use the knowledge of one's own role and those of other professions to appropriately assess and address the health care needs of patients and populations served
  • Interprofessional Communication: Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease
  • Teams and Teamwork: Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient-population-centered care that is safe, timely, efficient, effective, and equitable What is the common formal method of hand-off communication between two or more health care team members? -SOLUTION SBAR What are some ways to improve interprofessional communication? - SOLUTION - Choose effective communication tools
  • Organize and communicate information with everyone
  • Express one's knowledge and options with confidence
  • Listen actively
  • Give timely, sensitive, instructive feedback
  • Use respectful language appropriate for difficult situations
  • Recognize one's own uniqueness, experience level, expertise, hierarchy, etc.
  • Communicate consistently

What are some benefits of using SBAR? -SOLUTION - Creates common language for COMMUNICATION of key patient care information

  • Increases CONFIDENCE of both the speaker and receiver during the handoff report
  • Improves EFFICIENCY, efficacy, and accuracy of the handoff report
  • Improves the perception of effective communication What is the situation step of SBAR? -SOLUTION Describes WHAT IS HAPPENING AT THE TIME to require this communication What is the background step of SBAR? -SOLUTION Explains relevant background information that relates to the situation What is the assessment step of SBAR? -SOLUTION Provides an analysis of the problem or patient need based on assessment data What is the recommendation/request step of SBAR? -SOLUTION States what is needed or what the desired outcome is What does the "I" in I-SBAR stand for? -SOLUTION Identify (reminds the individual to identify himself or herself What does the "R" in I-SBAR-R stand for? -SOLUTION Response (the response that the receiver provides based on the information given) What does the "Q" in SBARQ stand for? -SOLUTION Questions (any additional questions that need to be answered) What is TeamSTEPPS? -SOLUTION Strategies and Tools to Enhance Performance and Patient Safety What are some of the common communication tools that are a part of TeamSTEPPS that are effective for promoting communication, patient safety, and teamwork? -SOLUTION - CUS words: State "I'm Concerned; I'm Uncomfortable; I don't feel like this is Safe"
  • Check backs: Restate what a person said to verify understanding by all team members
  • Call outs: Shout out important information (such as vital signs) for all team members to hear at one time

What are systematic reviews and integrative or meta-analysis studies - SOLUTION The researcher conducts a thorough literature search for appropriate studies and then analyzes findings of those studies to determine which best practices answer the research question T or F: The findings of the studies for systematic reviews cannot be generalized, but they provide a basis for future larger and better-designed research -SOLUTION True What are the six levels (strengths) of evidence? -SOLUTION - Level I: Systematic reviews, integrative/meta-analyses, CPGs based on systematic reviews, large multi-center clinical trials

  • Level II: Single experimental study (RCTs)
  • Level III: Quasi-experimental studies
  • Level IV: Nonexperimental studies
  • Level V: Case report/Program evaluation/Narrative literature reviews
  • Level VI: Opinions of respected authorities What is Quality Improvement (QI) (AKA the Evidence-Based Practice Improvment process [EBPI])? -SOLUTION A process in which nurses and the interprofessional health care team use indicators (data) to monitor care outcomes and develop solutions to change and improve care What are the primary interrelated concepts of Quality Improvement (QI)? - SOLUTION Evidence-based practice & safety What are the steps of the QI model the Plan-Do-Study-Act (PDSA)? - SOLUTION 1. Identify and analyze the problem (Plan)
  1. Develop and test an evidence-based solution (Do)
  2. Analyze the effectiveness of the test solution, including possible further improvement (Study)
  3. Implement the improved solution to positively impact care (Act) What are the steps of the more specific type of QI model the FOCUS- PDCA model? -SOLUTION - Find a process to improve
  • Organize a team
  • Clarify the current process
  • Understand variations in current process
  • Select the process to improve
  • Plan the improvement
  • Check for results
  • Act to hold the gain What does the QI method called the DMAIC model emphasize? - SOLUTION It includes the need to continue the new intervention or change over time What are the steps of the QI method the DMAIC model? -SOLUTION 1. Define the issue or problem
  1. Measure the key aspects of the current process for the issue (collect data)
  2. Analyze the collected data
  3. Improve or optimize the current process by implementing an evidence- based intervention/solution
  4. Control the future state of the intervention to ensure continuity of the process Nurses need to employ a spirit of inquiry to formulate PICOT questions. The PICOT format stands for what? -SOLUTION - Population/Patient Problem (such as falls)
  • Intervention (such as bed alarms to help reduce falls)
  • Comparison (use of reminder signage for staff instead of or in addition to bed alarms)
  • Outcome (fall reduction)
  • Time frame (during night shift, but time may not always be relevant) What are medical-surgical nurses' roles in the QI process? -SOLUTION - Employ a spirit of inquiry to formulate PICOT questions
  • Identify indicators (data) to monitor quality and effectiveness of health care
  • Access and evaluate data to monitor quality and effectiveness of health care
  • Recommend ways to improve care processes
  • Implement activities to improve care processes What is informatics? -SOLUTION The access and use of information and electronic technology to communicate, manage knowledge, prevent error, and support decision making

What is sound clinical judgment influenced by? -SOLUTION By how well the nurse knows the patient's typical response pattern and the situational context or culture of the nursing care unit What is failure to rescue (FTR)? -SOLUTION The inability of nurses or other interprofessional health team members to save a patient's life in a timely manner when a health care issue or medical complication occurs

  • FTR occurs when certain signs or symptoms are not noticed (failure to recognize) or accurately interpreted and therefore action to improve the patient's condition is not implemented (failure to escalate) What are the four key attributes of the failure to rescue (FTR) concept? - SOLUTION - Errors of OMISSION
  • Failure to RECOGNIZE changes in patient condition
  • Failure to COMMUNICATE patient changes
  • Failures in clinical decision making What skills does clinical judgment involve? -SOLUTION - Noticing
  • Interpreting
  • Responding
  • Reflecting What can clinical judgment prevent? -SOLUTION Failure to rescue What is a rapid response team? -SOLUTION Saves lives and decreases the risk for harm by providing care before a medical emergency occurs by intervening rapidly when needed for patients who are beginning to clinically decline Who may Rapid Response Teams consist of? -SOLUTION - Intensive care unit (ICU) nurse
  • Respiratory therapist
  • Intensivist (physician who specializes in critical care)
  • Hospitalist (physician, pa, nurse practitioner) What does the Joint Commissions's NPSGs include? -SOLUTION Includes the need for early intervention for patients who are clinically deteriorating

What is an early warning system (ERS)? -SOLUTION Used by many hospitals as a guide for the health care team to quickly determine a patient's condition on the basis of a physiologic scoring matrix What is the Modified Early Warning System (MEWS)? -SOLUTION A screening and scoring tool for medical-surgical nursing assessment to determine a patient's condition based primarily on the patient's level of consciousness (LOC) and RESPIRATORY RATE

  • Also includes measurements of systolic blood pressure, temperature, heart rate, oxygen saturation, and hourly urinary output (previous 2 hours) When do declines in either the level of consciousness or respiratory rate usually occur? -SOLUTION About 6 to 8 hours before a cardiac or respiratory arrest If the patient's condition deteriorates, the MEWS score triggers the need for medical intervention usually initiated by who? -SOLUTION The RRT (rapid response team) What is systems thinking? -SOLUTION The ability to recognize, understand, and synthesize the interactions and interdependencies in a set of components designed for a specific purpose What are the primary interrelated concepts of systems thinking? - SOLUTION - Quality improvement
  • Clinical judgment
  • Evidence-based practice
  • Patient-centered care T or F: Systems thinking can transform care provided to an individual as a result of patient-centered care or can influence organizational transformation among teams -SOLUTION True What are the four attributes of systems thinking? -SOLUTION - It is a DYNAMIC system on a continuum
  • Has a HOLISTIC perspective including multiple aspects
  • Seeks to identify PATTERNS within a complex situation
  • Is TRANSFORMATIVE creating change through insight and action
  • Withholding or withdrawing life-sustaining treatments What are health care disparities caused by? -SOLUTION - Poor communication
  • Lack of health care access
  • Inadequate health literacy
  • Primary health care provider biases and discrimination What are some factors that affect patient access to quality health care services? -SOLUTION - Geographic location
  • Cultural variables
  • Language barriers
  • Resources (insurance) What are some groups with health care disparities? -SOLUTION - OIder adults
  • Racial and ethnic minorities
  • LGBTQ populations What is a good way of rethinking concepts of sexuality and gender? - SOLUTION To think of each as existing along a spectrum rather than categorizing people into heterosexual/homosexual and male/female T or F: Include questions about gender identity and sexual activity as part of your patient's health assessment -SOLUTION True