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INTRO TO NURSING EXAM 2 - ROSS -
SPRING 2025
SBAR/I-SBAR-R - A structured way of relaying critical information in a spoken form. Positives include reliability, promoting patient safety, and clear format. I-SBAR-R replaced I of I-SBAR-R - Introduction. Can easily be forgotten due to nerves. Include your name and the patient you are taking care of. S of I-SBAR-R - Situation. A quick summary of why the call is being warranted (high bp, give data, etc.) B of I-SBAR-R - Background. Give a quick overview of patient's history pertaining to event (Ex. New onset of high blood pressure, becoming symptomatic with a bad headache) A of I-SBAR-R - Assessment. Explain what you are seeing (Ex. My assessment is showing that his high blood pressure is why his headache pain has increased) First R of I-SBAR-R - Recommendation. This can be a "scary" part, but so crucial. You are the eyes for the physician. Tell them what you think could help or what you need (Ex. Would it be possible to get some blood pressure medicine to help control this?) Second R of I-SBAR-R - Read Back. Once you receive new orders, repeat back to them. It's always good to verify as these conversations can happen so quickly (Ex. 'Order: IV labetalol 10mg. May repeat twice'). Professional Boundaries - the spaces between the nurse's power and the client's vulnerability. The power of the nurse comes from the professional position and the access to private knowledge about the client Boundary violations - occurs when there is confusion between the needs of the nurse and those of the client. Ask yourself this question: Could I feel comfortable telling a colleague about my interaction with this patient?"
Zones of professional behavior - Under-involvement, Zone of helpfulness, and over-involvement. Under-involvement (Zones of Professional Behavior) - distancing yourself, showing disinterest, neglect Zone of helpfulness (Zones of Professional Behavior) - the ideal space or that area of a therapeutic relationship Over-involvement (Zones of Professional Behavior) - sharing personal information by the nurse, secrecy, touching, gestures, money or gifts, sexual misconduct Consequences of professional boundary violations - Violation of nursing code of ethics, Reportable offense shared with your state board of nursing, Employer involvement, and/or Possible termination Phases of Nurse-Patient Relationships - Orientation, working, and termination. Has to be started first and foremost prior to any other steps can. Begin in the nursing process. Orientation (Nurse-Patient Relationship) - The "getting to know you" phase. Establishing trust is crucial. First impressions can set the tone of how the relationship will be. Outline and explain the activities ahead Working phase (Nurse-Patient Relationship) - The portion of which you conduct what you laid out for in the orientation phase. Patients may exhibit some periods of resistance to change (Ex. Someone getting a new diagnosis of congestive heart failure). Work through this with your patient, continue to be encouraging, promote active listening and focus on continuing building of trust. Termination (Nurse-Patient Relationships) - The activities that enable the nurse and patient to end their relationship, but making sure it's done in a therapeutic manner (Ex: Discharge after outpatient surgery or patient out of hospital). Levels of communication - Verbal, Nonverbal, Congruent, and Incongruent communication. Verbal Communication - Consists of speech (obvious form)
Ethical principles - Autonomy, Beneficence, Nonmaleficence, Justice, Fidelity, and Veracity. Autonomous decisions - decisions based on Individual values, adequate information, Freedom from coercion, and Reason and deliberation Beneficence - Based on promoting good for others. Providing pain medication to an elderly person who fell and broke a hip Nonmaleficence - Duty to do no harm. Foundation of medicine's Hippocratic Oath. Also critical to nursing profession. Stopping a medication known to be harmful. A collapsed client at the mall Principal of double effect - One may produce a distressful or undesirable effect if intent is to produce overall good result (Ex. Chemotherapy, organ transplant, etc). Justice - Equals should be treated the same and unequals should be treated differently; In health care, this relates to allocation of resources; If you were juggling multiple patients, you would not provide better care based on who has the best insurance or who you liked better Fidelity - Faithfulness or honoring one's commitments or promises; Key foundation for the nurse-patient relationship; Key for upholding the Code of Ethics for Nurses; Key for maintaining competence; (Ex. A patient requests that a nurse not reveal his terminal diagnosis to his family. The patient explains that his family would probably disregard his wishes and keep him alive no matter the circumstances). Veracity - Telling the truth, not lying; Fundamental to continued trust between people; Two exceptions can exist for nurses, including If a patient asks not to be told the truth, If a patient is mentally incompetent, and iif a patient was starting chemotherapy and asked about the side effects, a nurse practicing veracity would be honest about the side effects they could expect with chemotherapy. Code of Ethics - Defined as a social contract through which the profession informs society of principles and rules guiding its function Scope and Standards of Practice (ANA, 2004) - Defines standards of practice and standards of professional performance
Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) - Nursing profession's expression of its ethical values and duties to the public International Council of Nurses Code of Ethics for Nurses (ICN, 2005) - Rights and responsibilities of nurses related to people, practice, society, co-workers, and the profession Steps in Ethical Decision-Making - Clarify the ethical dilemma (self-reflection AND through patient's and loved one's point of view); Gather additional data (Hospital Ethical Board); Identify options; Make a decision (team Inter-professional); Act; Evaluate Living will - A legal document that spells out medical treatments you would/ would not want to be used to keep you alive, as well as your preferences for other medical decisions such as pain management or organ donation. Power of Attorney - A written authorization to represent or act on another's behalf in private affairs, business, or some other legal matter. The person authorizing the other to act is the principle, grantor, or donor. Advanced Directive - a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity Types of Learning - Visual, Auditory, and Kinesthetic Visual Learning - Learning that is done by seeing Auditory Learning - Learning that is done by hearing Kinesthetic Learning - Learning processes done by touching, feeling, or doing. Basic Principles of Learning - Use of Relevance, Maturation, Reinforcement (+/-), Organization, Timing, Motivation, Readiness, Participation, Repetition, and Understandable words
Andragogy - Adult learning (Active). Adults want to participate in learning Teaching Strategies - Lectures, Discussion, Demonstration, and Role Playing Lectures (Teaching Strategies) - Formal presentation; Most effective for cognitive learning; Most effective when combined with discussion; Could be boring Discussion (Teaching Strategies) - Helps with sharing, clarifying feelings, and asking questions; Is deeper because it involves participation; Good for cognitive and affective domains of learning Demonstration (Teaching Strategies) - Good for psychomotor skills; Explaining as skill with a demonstration; Video and audio tapes; Human contact is the preferred method; Praise is important!!!! Role Playing (Teaching Strategies) - Especially important for teaching affective domain of learning; Used to work through past, present, and anticipatory feelings or new situations; Ask a child to demonstrate how his or her mother's illness has affected the family by using dolls
