Role Scope Leadership Study Guide for Exam 2 PDF

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notes for exam and was very helpful. the questions are good...

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Study Guide for Module 6 Exam #2 Evidence Based Practice: o What is it? Evidence-based medicine: integration of best research evidence with clinical expertise and the patient’s unique values and circumstances in making decisions about the care of individual patients. o Steps:  0 Cultivate a spirit of inquiry.  1 Ask the burning clinical question in PICOT (patient, intervention, comparison, outcome, and time frame) format.  2 Search for and collect the most relevant best evidence.  3 Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and synthesis).  4 Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change.  5 Evaluate outcomes of the practice design or change based on evidence  6 Disseminate the outcomes of the EBP (evidence-based practice) decision or change. How does research improve practice? EBP is a priority for all health care providers in order to ensure patient safety. EBP promotes the use of effective strategies to help patients be well. It also helps nurses prevent harm to their patients, to themselves, or to the global community. Florence Nightingale is considered the first person to use research in nursing to elevate it to the status of a profession (Catalano, 2009). Simple sanitary practices, such as hand washing, were promoted by Nightingale and became commonplace in modern society. What sources can help nurses use EBP?  Information dissemination: Journals, Conferences, Educational programs, Media  Literature review American Nurses Association Research Toolkit: www.nursingworld.org/Research-Toolkit Arizona State University College of Nursing Center for the Advancement of Evidence-Based Practice (CAEP): https://nursingandhealth.asu.edu/evidence-based-practice/ University of Iowa College of Nursing Evidence-Based Practice Guidelines: www.nursing.uiowa.edu/excellence/evidencebased-practice-guidelines The Joanna Briggs Institute: www.joannabriggs.edu.au The Sarah Cole Hirsch Institute for Best Nursing Practices Based on Evidence: http://fpb.case.edu/Centers/Hirsh/ ONS PEP ® Putting Evidence into Practice. www.ons.org/Research/PEP The Ohio State University Center for Transdisciplinary Evidence-

based Practice (CTEP): http://nursing.osu.edu/sections/ctep/ The Registered Nurses Association of Ontario Nursing Best Practice Guidelines: www.rnao.org/bestpractices/ University of Texas Health Science Center at San Antonio's Academic Center for Evidence-Based Practice (ACE): www.acestar.uthscsa.edu/ This is Box 21-2 in the book I think this is what she is talking about but not sure.

Patient Centered Care: What is patient centered care? Patient-centered care supports active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. Recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values and needs. Understand the effects of culture and language on the provision of patient centered care. Culture: a group's acceptance of a set of attitudes, values, beliefs, and behaviors that influence the way that the members of the group express themselves. Cultural expression Language Spirituality Art and Music Customs and traditions Food preferences Response to illness, stress, pain, grief, anger, and sorrow; Decision-making Cultural Orientation: Behaviors, beliefs, and attitudes are transmitted from one generation to the next. Expressions of culture are primarily unconscious. They have a profound effect on an individual's interactions and response to the health-care system. Nurses who understand the essential characteristics of transcultural nursing will be able to provide competent and culturally sensitive care for clients from all cultural backgrounds. So then Diversity explains the differences between cultures. Primary characteristics are those that are more obvious, such as nationality, race, color, gender, age, and religious beliefs. Secondary characteristics are harder to identify, such as socioeconomic status, education,

occupation, length of time away from the country of origin, gender issues, residential status, and sexual orientation. Cultural competence as it relates to nursing is the provision of effective care for clients who belong to diverse cultures, based on the nurse's knowledge and understanding of the values, customs, beliefs, and practices of the culture. Primary skills required Communication Understanding Sensitivity Recognize that the nurse comes from a particular culture that has its own set of health-care values. Identify the culture of the client and recognize specific health-care practices. Barriers to communication Lack of a common language Not understanding nonverbal cues Not understanding where men and women "fit" in the society Using loud or aggressive tone of voice Being confrontational Nurses develop cultural awareness only when they can recognize and value all aspects of a client's culture, including beliefs, customs, responses, methods of expression, language, and social structure. Merely learning about another person's culture does not guarantee that the nurse will have cultural awareness. Work with the client's beliefs and cultural values to make changes that will improve health. What is health literacy and what is its impact on client-centered care? The concept of Health Literacy is comprised of two components: a capacity within the individual to understand words, phrases and concepts and the nature or clarity of the health information that is being conveyed. Thus, health literacy is dynamic and situational. It includes oral and written communication, as well as the ability to act upon the information. The average reading level of American adults is about 7th to 8th grade level. A readability score is given as a "grade level," but a score doesn't tell us whether an adult with a specific level of education will be able to read the text. In 2016, the United States had a larger percentage of adults performing at both the top and bottom of the distribution. Thirteen percent of U.S. adults performed at the highest proficiency level, but 18% perform at the lowest proficiency level. Clearly, we have a divide.

Advocacy:

Understand the premises of Patient Centered Care and the RN’s role in providing it.

How do nurses advocate for their patients? * ADVOCACY APPLIES IN EVERY SCOPE OF NURSING ** • 1. the nurse supports clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care • 2. Nurses must act as advocates even when they disagree with clients' decisions. • 3. Nurses must advocate for clients when the health care system is not acting in their best interests. What is the nurses’ role in effecting changes in health policy? Be up to date on cutting edge research, lead by example. * HOLD AN INSERVICE. How can a nurse become involved in political advocacy? They have the following credentials: self-confidence, motivation, creativity, a capacity to change, and persistence. • Become active in a professional organization. Develop a Political Relationship with a local Legislator. • ** MANY POLITICIANS DO NOT HAVE BACKGROUND IN HEALTHCARE, THEREFORE NURSES NEED TO BE INVOLVED IN TALKING TO THEM. THEY DO NOT HAVE A BACKGROUND IN HEALTHCARE ** What are the Nurse Practice Acts? Where are they found? Each state has its own Nurse Practice Act, and it is every nurse's responsibility to become familiar with it. The State Board of Nursing will have links to the Practice Act; these Boards have the authority to issue and revoke a nursing license based upon compliance or violation of the Nurse Practice Acts. Standards of care are developed by the ANA and other professional organizations, and they direct the level of care given by nurses. Nurses should refuse to practice beyond the scope of their practice or outside of their area of competence.

Clinical Judgment and Decision Making: Review the steps of the Nursing Process.

ADOIE • - Assessment: includes physiological data, psychological, sociocultural, spiritual, economic, and life style factors. • - Diagnosis: a nursing diagnosis is the nurse's clinical judgment about the client's response to actual or potential health conditions or needs. • - Outcomes/Planning: based on the assessment and diagnosis, the nurse sets measurable

and achievable short and long range goals for the patient. • - Implementation: Nursing care is implemented according to the care plan • -Evaluation: Both the patient's status and the effectiveness of the nursing care must be continuously evaluated and the care plan modified as needed. How are they applied to Leadership, Management, & Clinical Judgment? Critical thinking and clinical reasoning are thinking processes; clinical judgment is the result of the thinking (the opinions you form or decisions you make). Critical thinking (and clinical reasoning and clinical judgment) in nursing: • Is guided by standards, policies, ethics codes, and laws (individual state practice acts and state boards of nursing). • Is based on principles of nursing process, problem-solving, and the scientific method (requires forming opinions and making decisions based on evidence). • Focuses on safety and quality, constantly reflecting, re-evaluating, self-correcting, and striving to improve. • Carefully identifies the key problems, issues, and risks involved, including patients, families, and key stakeholders in decision-making early in the process. (Stakeholders are the people who will be most affected [patients and families] or from whom requirements will be drawn (e.g., caregivers, insurance companies, third-party payers, health care organizations.) • Applies logic, intuition, and creativity and is grounded in specific knowledge, skills, and experience. • Is driven by patient, family, and community needs, as well as nurses' needs to give competent efficient care (e.g., streamlining charting to free nurses for patient care). • Calls for strategies that make the most of human potential and compensates for problems created by human nature (e.g., finding ways to prevent errors, using technology, and overcoming the powerful influence of personal views). How is it similar to Critical Thinking?

Another way to look at it is through critical thinking. If you add your critical thinking skills (reasoning gained outside of the clinical setting) and add it to your critical reasoning skills (gained inside the clinical setting), you'll have a complex thought process of problem solving and patient centered care. Add your past experiences, your intuition, your culture, your morals and ethics, and combine them with your patient's situation; you'll soon be thinking like a nurse!

What is the decision making process? Is a purposeful and goal directed effort that uses a systematic process to choose among options. 1.identify the problem and DEFINE it 2. gather data 3. analyze data 4. identify the options/solutions 5. Pros and cons of each options 6. selection - make the DECISION How important is it to first identify the problem? To achieve the outcomes.

Anything previously tested is possible to appear again! Review the various types of Leadership. a. Leadership styles i. Laissez-Faire 1. Leave it alone, permissive, nondirective, or passive 2. Allows members to determine own goals and methods to achieve them 3. Little planning, minimal decision-making and lack of involvement by the leader 4. Good for: research labs 5. Everyone should have the same level of education as the leader and leader performs the same tasks as group members 6. Leaves people feeling lost and frustrated because of lack of direction 7. Only points out flaws or when you are doing something wrong 8. Avoids decision making in hopes that the problem will resolve itself ii. Democratic Style 1. Supportive, participative, transformational 2. Attaining goals, planning, and success for projects are shared by group 3. Beliefs a. Everyone needs to participate b. Limits established by group, expression is allowed to maximize creativity c. Each person accepts responsibilities for themselves and the welfare of the group d. Each person must respect everyone in the group as unique and valuable 4. Provides guidance to the group, everyone shares control

5. good for groups with equal status and know each other well because they have worked together for a long time 6. can be time-consuming and inefficient group members disagree strongly a. in the end strong sense of ownership and achievement by the whole group 7. Hallmark Trust, collaboration, confidence, and autonomy 8. Followers have high level of commitment resulting in strong work ethic and innovative ideas 9. Some leaders are uncomfortable with this style because of the minimal control over the group 10. Allows leader more control over the final decision after considering all opinions iii. Authoritarian Style 1. Controlling, directive, autocratic 2. Controls group and activities 3. Gives orders- must be carried out 4. Decision-making is up to the leader only a. Input maybe considered 5. Micro managers- closely monitor everything in the group and often make on-the-spot changes they know will work 6. Followers- harbor hostile feelings, fearful to expression, passiveaggressive to try even the playing field, feel oppressed and unable to work to their full potential 7. Dictatorial leadership a. Dictator- extreme authoritarian leadership b. No regard for feelings and needs of the group c. Goal is the only thing that matter and has to be done their way d. Uses harsh criticism e. Example: Military mission to destroy a terrorist group by a Delta Force assault team 8. Benevolent leadership a. More paternalistic b. Attempts to include the groups in final decisions c. Condescending and patronizing d. Works best in emergency situations i. Directions are clear- required to save a life or prevent injury ii. Organize large groups e. Highly efficient in achieving goals and completing tasks f. Suppresses creativity and may reduce long-term effectiveness of group g. Reduces motivation levels

i. Leads to passive-aggressive behavior which in return reduces the effectiveness of the group h. Long-term: can cause followers to be frustrated and rebellious iv. Many leaders use multiple leadership styles depending on the situation 1. External regulations and requirements, ability of the group, work setting, problem being solved Review the principles of Delegation and Prioritization.

Delegation is recognized as designating ancillary personnel for the responsibility of carrying out a specific group of nursing tasks in the care of certain clients. Delegation includes the understanding that the authorized person is acting in the place of the RN and will be carrying out tasks that generally fall under the RN's scope of practice. However, the person taking on the RN-level task must be qualified to perform the task within the nurse's state practice act Although LPNs and LVNs can do most skills, for the NCLEX they:       

•Cannot do admission assessments. •Cannot give intravenous (IV) push medications. •Cannot write nursing diagnoses. •Cannot do most teaching. •Cannot do complex skills. •Cannot take care of clients with acute conditions. •Cannot take care of unstable clients.

For questions concerning UAPs, CNAs, and aides on the NCLEX:    

•Look for the lowest level of skill required for the task. •Look for the least complicated task. •Look for the most stable client. •Look for the client with the chronic illness. RN

UAP

LPN

Admission assessment

Vital Signs

Feeding

IV Meds

Uncomplicated Skills

Basic Hygiene

Blood Products

Stable Clients

Basic Skills

Care Plan

Chronic Disease

Stable Clients

Client Teaching Unstable clients Acute Disease

Oral & IM meds

Chronic Disease Ambulation

.

Review ethics, ethical behavior, and values.

Review Quality Improvement. a. Quality Improvement v. continual analysis and evaluation of products and services to prevent errors and to achieve customer satisfaction vi. never Stops vii. Steps: Identify, assemble, collect, establish, select plan, Evaluate viii. Focuses on patient quality and safety

Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvements in health related services and in the overall health and/or safety of individual patients. 2. 3. 4. 5. 6. 7.

Identify the need Assemble a team Collect the data Establish outcome and quality indicators Select and implement a plan Evaluate

Review pharmacologic principles....