Evidence-Based Practice (EBP) in Nursing, Exams of Advanced Education

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Intro to Nursing Exam 2 step 0 EBP cultivate a spirit of inquiry step 1 EBP Ask clinical questions in PICOT format step 2 EBP Search for the best evidence step 3 EBP Critically appraise the evidence step 4 EBP Integrate the evidence with clinical expertise and patient preferences and values step 5 EBP Evaluate the outcomes of the practice decisions or changes based on evidence step 6 EBP Disseminate EBP results Evidence Based Practice An ongoing curiosity about the best evidence to guide clinical decision making PICOT P: Population I: Intervention C: Comparison O: Outcome T: Time Rounding communication -interdisciplinary -Nursing -Therapies Care conference communication multidisciplinary Handoffs communication Nurse to nurse Nurse to ULP vice versa Nurse to care provider and vice versa care provider to care provider and vice versa Bedside report type of handoff involves patient OR timeouts prevents wrong site surgery Outcomes of good teamwork 1) reduced length of stay 2) higher quality of care 3) better patient outcome 4) meet family needs 5) care score increase 6) lower nurse turnover negative outcomes 1) medication errors 2) delay in treatment 3) wrong site surgeries Barriers for working conditions 1) lack of coordination 2) distractions 3) misinterpretation of cues 4) Hierarchy 5) shift change Barriers for communication 1) lack of time 2) workload 3) processess 4) Technology Our Role as Nurses: IM SAFE I Illness the human response is caused by the human response is caused by etiology the outcomes stem from the defining characteristics the outcomes are written in SMART format Identify each intervention A) Acute pain caused by inflammation; pain report of 8/10; grimacing with movement B) Diminished pain; client rates pain </= 3 at all times during hospital stay C) Client does not grimace with movement during hospital stay A) human response B) goal C) Outcome interventions are aimed at changing the etiology what you are saying is causing the problem you must have more than _____ intervention for your patient and include a variety ________________________________________________________________ more than 1 intervention include a variety (diagnostic, therapeutic/treatment, education, collaboration) interventions must be supported by evidence!! interventions must be _______ and _________ clear and specific evaluating your plan of care step 1 Reassess the patient evaluating your plan of care step 2 compare the findings with the outcome criteria -must determine the progress as "met" or "unmet" or "progressing" evaluating your plan of care step 3 Revise the plan of care May need to -identify a different human response -need to revise the goal/outcomes -need to revise the interventions what is the reverse human response goal what are the types of intervention 1) Assessment 2) Therapeutic/treatment based 3) collaborative 4) educational Identify which ethical principle or theory for the following examples In clinical situations nurses respect a patient, where the patient is allowed the freedom of choice regarding treatment, such as in deciding whether he/she wishes to be intubated during an exacerbation of COPD, or deciding when he/she wishes to forgo further dialysis. If a patient lacks capacity for such a decision and has an advance directive, the person who has the durable power of attorney can make the decision. autonomy An elderly patient falls at home and has a fractured hip. In the emergency room, the nurse acts to provide pain medication as soon as possible beneficence A patient asks the nurse not to reveal the fact that she is dying or give her diagnosis to his family. The nurse asks why she does not want her family advised. The patient explains that her family is very emotional and has stated they would do everything to keep her alive, even if it required long-term mechanical ventilation. The patient has explained multiple times that she does not want mechanical ventilation. The nurse recognizes that keeping of this information in confidence, while supporting the family, is an example of fidelity When this elderly person above received pain medication (an act of beneficence) there are complications that could arise. Practitioners recognize that using a narcotic may cause confusion. When obtaining the consent for her hip surgery, we want to make certain that the patient is alert enough to understand the risks and benefits of the procedure. We must balance the __________ of providing the medication quickly with the possible _________ of obtaining a consent when patient does not have the capacity to make the decision for surgery. balance the beneficence with possible maleficence A hospital organization wishes to donate low or no-cost pediatric dental services to the community. There are openings for 45 children per month. _________ requires a fair method, that is free from bias, to determine who will receive these services. justice Patient has repeatedly voiced fear over receiving a diagnosis of lung cancer, as he believes this is a death sentence. His primary care physician decides not to reveal the diagnosis to the patient after he says he would kill himself if he had lung cancer. paternalism An example, often used, is female genital circumcision. One side calls it female genital mutilation. Another group may consider this an appropriate cultural rite of passage. —is this a cultural issue or human rights issue? Since it is performed on girls as young as seven years old, the issue of assent, consent, and culture are prominent in ethical discussions. ethical relativism Individuals would examine their intentions to determine the ethics of their actions. For example, we have begun not to use restraints on older people for their safety and to think of other measures. We do this because restraining someone against his or her will could not be considered a universal law. deontology Health care providers triage rapidly, electing to use resources to provide the most care to the greatest number of people, as opposed to expending maximum resources on a single critically ill person who is unlikely to survive. utilitarianism why ethics in nursing? Because nurses -care for vulnerable populations and individuals -promise to treat our patients with respect and dignity regardless of the individual, situation, or reason what are morals? describe the "good or bad" or "right or wrong" of actions ethics = behaviors the overall goal is the reversal of the human response ANA code of ethics S- specific M- measurable A- achievable R- realistic T- timed Identify which statements are objective or subjective. A 48 year old patient who comes into the ER stating, "I feel like I can't breath." His respirations are 28 breaths per minute and his heart rate is 115 beats per minute. The patient then grabs his chest and says, "My chest hurts so bad help!" You ask the patient to rate his pain on a scale from 0-10, 10 being the worst pain ever. The patient replies, "10, it hurts so badly!" You then ask the patient to describe what the pain feels like, the patient reports it feels like pressure. Your patient then starts to become diaphoretic and pale. You do an EKG that shows sinus tachycardia. The pulse oximeter shows 100% on room air and the patients blood pressure is 120/80. Objective- 48 year old male 28 breaths per min heart rate 115 diaphoretic and pale tachycardia pulse ox 100% 120/80 Subjection- "I feel like I can't breathe" "My chest hurts so bad, please help." "10, it hurts so badly" feels like pressure what are ethics? describe generally accepted set of moral proniciples The "shoulds" and "oughts" of life if a person has a potential problem you would use risk for statements What does the nurse have to do before planning care? Assess the pt. Evaluation is the last step in the nursing process. State the correct order for the rest of the steps in the nursing process? 1) Assessment 2) Analysis 3) Planning 4) Implementation When writing a nursing care plan statement, the "Human Response" refers to which of the following? The patients need Client states that her pain is throbbing. subjective or objective? subjective Client states that her pain is throbbing. Subjective or Objective? objective Client's lungs sounds are clear bilaterally. Subjective or objective? objective Complete the following nursing care plan statement: Acute pain r/t inflammation aeb... Pain rated at 7 out of 10 The overall goal stems from what part of the nursing care plan statement? Human response The outcomes stem from what part of the nursing diagnosis statement? signs and symptoms The interventions that the nurse performs stems from what part of the nursing diagnosis statement? etiology SMART criteria for outcomes stands for: Specific, Measurable, Attainable, Realistic, Timed true or false ? true Which of the following are true about interventions? Choose all the correct. A Geared towards the human response B Geared towards the etiology C Must be written in SMART criteria D Must be supported by rationale B and D When should the nurse should evaluate a patient? Select all correct answers. A Continuously B During a focused assessment C When discharged from a unit D One time per shift A,B,C You're working at a student health clinic at a university. A 20 y/o female student comes in with a primary complaint that she feels "stressed out" & is having issues with sleep & states, "I want a sleeping pill to sleep better." She states that she can't easily fall asleep or stay asleep most nights for the past 2 months. She's feeling frustrated when she goes to bed at night & that she tries to watch tv & exercise prior to falling asleep. She's having difficulty concentrating on school work & has missed several classes d/t feeling "tired" during the day. She sleeps only about 4 hrs/night & it takes her about 2 hours to fall asleep & she wakes up 4 - 5 times/night. Vitals: WNL (within normal limits) Weight: WNL Appearance: normal for age group/situation, however, dark circles are apparent under her eyes bilaterally. Physical exam: WNL. Which of the following would be in your problem list? A Trouble falling & staying asleep B Vital signs WNL C Feels "tired" can't concentrate & has missed class D "Stressed out"/anxiety A, C, D What is your priority problem for the case study in previous course? sleep deprivation Which of the following is an appropriate etiology (caused by) statement for sleep deprivation? Inadequate sleep hygiene See 14 more