Ignatavicius: Medical-Surgical Nursing, 9th Edition Key Points-Chapter 01: Overview of Professional Nursing Concepts for Medical-Surgical Nursing

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The scope of medical-surgical nursing, sometimes called adult health nursing, is to :
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The scope of medical-surgical nursing, sometimes called adult health nursing, is to :
promote health and prevent illness or injury in patients from 18 years of age to older than 100 years of age.
Medical-surgical nursing requires special knowledge and clinical skills to meet the needs of:
adult patients in a variety of settings across the continuum.
Patients are recipients of care in:
mutually trusting relationships with nurses and other members of the health care team.
Medical-surgical nurses focus on meeting the basic needs (concepts) of adult patient in the areas of:
1. fluid and electrolyte balance
2. protection
3. oxygenation and tissue perfusion
4. mobility
5. sensation
6. cognition
7. nutrition
8. metabolism and bowel elimination
9. sexuality—to provide a holistic approach to patient care.
The nurse can function in various roles as a:
care coordinator, transition manager, caregiver, patient educator, leader, and patient and family advocate.
To function in these roles, nurses need to have:
the knowledge, skills, and attitudes /KSA's, to keep patients and their families safe.
Nurses play a major role in coordinating care with:
the interprofessional team to promote safe, quality care.
The Joint Commission /TJC requires that healthcare organizations create a culture of:
SAFETY and encourage patients and families to become safety partners in protecting patients from harm.
National Patient Safety Goals /NPSGs address:
high-risk issues such as drug administration, fall reduction, pressure ulcer prevention, infection prevention, and communication among health care team members.
Sentinel events are a
severe variation in the standard of care caused by human or system error and results in an avoidable patient death or major harm and are always reported.
The six core competencies for health care professionals based on research by the Institute of Medicine and Quality and Safety Education for Nurses are:PATIENT-CENTERED CARE, TEAMWORK AND COLLABORATION, EVIDENCE-BASED PRACTICE, QUALITY IMPROVEMENT, INFORMATICS AND TECHNOLOGY, and SAFETY.Nurses, as advocates for:the patient and family, teach them how to be empowered and have more control over their care.Characteristics of patient-centered care include:respect values, preferences, and needs, coordination of care, information, communication, and education, comfort, emotional support, involvement of family and friends, transition and continuity, and access to care.Nurses function as coordinators of care by:communicating and collaborating with members of the health care team.Consideration of the special health care needs of the:LGBTQ population has been added to the Healthy People 2020 initiative because of health disparities and previous discrimination. Include questions about gender identity and sexual activity as part of the health history.As part of the QSEN KSAs /knowledge, skills, and attitude, the competencies of:TEAMWORK AND COLLABORATION are key components to achieving quality patient care. Interdisciplinary communication is essential when planning, implementing, and evaluating patient care.Such communication may be provided partly via e-mail:but is better accomplished through face-to-face and phone communications.A lack of communication has been shown to cause many:medical errors and patient SAFETY risks.An NPSG was established to communicate ongoing patient care needs:such as pain management and respiratory support, to post-discharge caregivers.The SBAR procedure or a similar established protocol is used for:successful communication among caregivers and among health care agencies.SBAR is a :formal method of communication between two or more members of the health care team that includes these four stepsDescribe what each section of SABR relates to:Situation: Describe what is happening to require this communication. Background: Explain any relevant background information. Assessment: Provide an analysis of the problem based on assessment data. Recommendation/Request: State what is needed or what the desired outcome is.Modifications of SBAR include I-SBAR, I-SBAR-R, and SBARQ:The additional letters represent: "I"—identify self, "R"—response receiver provides, and "Q" - questions that need to be answered.TeamSTEPPS is another communication approach to improve:safety and quality. o S—Strategies o T—Tools o E—Enhance o P—Performance o P—Patient o S—SafetyNurses delegate certain nursing tasks and activities to:unlicensed assistive personnel /UAP, such as patient care technicians /PCTs or nursing assistants /CNAs.Delegation is the process of:transferring to a competent person the authority to perform a selected nursing task or activity in a selected patient care situation.Five rights are followed when delegating and supervising a nursing task or activity to a UAP:Right task Right circumstances Right person Right communication Right supervisionThe nurse is always responsible for the task or activity:that is delegated.Evidence-based practice or EBP is the:integration of best current evidence to make decisions about patient care. It considers the patient's preferences and values, as well as one's own clinical expertise.Quality Improvement or QI, sometimes called evidence-based practice improvement or EBPI, ensures: patientSAFETY by systematically reviewing procedures, processes, and care to continuously improve the care and safety for patients.The KNOWLEDGE , SKILLS, and ATTITUDE, have specific tools to measure QUALITY IMPROVEMENT:including root cause analysis and impacting changes in care processes.Nurses are active participants in the:systematic QUALITY IMPROVEMENT process in their health care agency.Informatics involves using:information and technology to communicate, manage knowledge, mitigate error, and support decision-making.INFORMATICS and technology are used for:patient documentation, electronic data access, and health care resource tracking. Nurses play a key role in promoting SAFETY and preventing errors, including "missed nursing care."Clinical judgment is the process that nurses and the health care team use:to make decisions based on interpretation of the patient's needs or problems. The nursing process, critical thinking, and a variety of reasoning patterns help the medical-surgical nurse make clinical decisions.The worst result of poor judgment is failure to rescue:which occurs when early signs and symptoms are not noticed or accurately interpreted and, action to improve the patient's condition is not implemented.Attributes of clinical judgment include:Assessment: Noticing Analysis/Interpreting Planning/Strategy Implementation/Responding Evaluation/Effective vs. IneffectiveRapid Response Teams are one initiative:to save lives and decrease the risk for patient harm before a respiratory or cardiac arrest occurs.Members of Rapid Response Teams are:critical care experts who are on-site and available at any time to respond to calls for assistance.Early clinical changes in condition occur in most patients for up to:48 hours before a "Code Blue." is called. Therefore, observe for, document, and communicate early indicators of patient decline, including decreasing blood pressure, increasing heart rate, and changes in mental status.The three ethical principles to consider when making clinical decisions are:selfdetermination, beneficence, and justice.Respect for people is one of;six basic ethical principles that nurses and other health care professionals should use as a basis for clinical decision-making.Respect implies that patients are treated as:autonomous individuals capable of making informed decisions about their care.Patient autonomy is referred to as:self-determination or self-management.The second ethical principle is beneficence:which emphasizes the importance of preventing harm and assuring the patient's well-being.Nonmaleficence follows the QSEN core competency of safety, ensuring:patient SAFETY and preventing harm.Fidelity refers to the nurse:keeping his or her obligation to follow through with care.Veracity is the principle that the nurse:has an obligation to tell the truth, to the best of his or her knowledge.Social justice refers to:equality, which means that all patients should be treated equally and fairly.The National Council of State Boards of Nursing identified nine nursing practice areas needing improvement, including:medications, communicating data and assessments, attentiveness to patients, clinical reasoning, prevention of errors or complications, timely intervention, interpreting orders, professionalism and advocacy, and mandatory reporting.Health care organizations vary by:size, mission, financial goal, and purpose; some are single agencies and others are part of large networks in multiple locations.Health care disparities are differences in the access or availability of health care:; members of minority groups and other vulnerable populations are particularly at risk for health disparities.The lesbian, gay, bisexual, transgender, queer and/or questioning /LGBTQ, population typically does not:trust health care professionals; use sensitive questioning about sexual orientation and gender identity as part of your interview with patients in this group.The Healthy People 2020 initiative added a category for these individuals because of:health disparities in this population and the need to improve LGBTQ health.