Download QSEN Exam Prep: Key Concepts in Nursing Safety and Quality and more Exams Advanced Education in PDF only on Docsity!
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Major barrier to making progress in safety and quality - Answer failure to appreciate work complexity
complex work environments - Answer time pressure, high stakes, inadequate info, ill defined goals, poor procedures, dynamic conditions, people working in teams, stress
recognition primed decision process - Answer cues expectancies goals actions + situation
adjust actions to fit
more experience deal with situations with more confidence
environments prone to - Answer distraction
slips - Answer break in routine when attention is diverted
capture- more frequently used routine takes over
description- right action on wrong object
associative activation- go to phone when doorbell rings
loss of activation- forget what you are doing when you rise to get up
mistakes - Answer rule based- wrong rule chosen
knowledge based- lack of knowledge or misinterpretation of problem (pattern matching, confirmation bias, overconfidence, deminimus)
factors that divert attention - Answer physiologic- sleep, drugs, illness, etc
psychological- anxiety, emotion
environmental
characteristic of complex adaptive systems - Answer embeddedness, distributed control, nonlinear, adaptable elements, emergence, diversity, order/disorder, self organization
coordinating knowledge mindset goals - Answer goals, conflict, obstacles, hazards, data, behavior
adapt, anticipate, accommodate, react, cope
3 aspects of rn work in context - Answer factors that make actual care delivery complex
cognitive factors leading to care delivery decisions
strategies used to manage complexity in care delivery
work complexity patterns - Answer interruptions, missing supplies, waiting on systems, inconsistency in communication, lack of time, early learning curve for new process and lack of fit with other work
knowledge patterns - Answer knowing patient information, typical patient profiles, unit routine and workflow
care management strategy patterns - Answer stacking
anticipating
proactive monitoring
strategic delegation
memory aids
workarounds
challenges to cognitive work of nursing - Answer frequent cognitive shifts, interruption, cognitive load prone to disrupting attention
5 major categories of nursing obstacles - Answer med, order, supplies, staffing, equipment,
average nurse time at one task is 3.1 sec and nurses interrupted mid-task 8 times per shift
missed nursing care - Answer ambulation, turn, feedings, education, discharge planning, emotional support, hygeine, i/o documentation, surveillance
reasons for missed care - Answer too few staff, time, poor use of existing staff resources, its not my job syndrome, ineffective delegation, habit, denial
complexity compression - Answer personal, environmental, practice, systems and technology, administration and management, and autonomy and control. In particular, system, practice, and autonomy and control factors lead to complexity compression.
limitation of content knowledge - Answer work isnt linear, equal goals need attention at same time, unreliable support and resources, RNs have human limitation, managing work flow requires org and prior skills specific to situation
nursing care requires - Answer engaged reasoning, relationship, and context to make qualitative distinctions that lead to effective nursing practice
what nurses bring to a caring situation and the context surrounding the situation influences clinical judgement more than objective information
nursing education - Answer although scientific evidence is essential to good practice,
basic computer skills, info management, info literacy
national health information technology strategic framework (2004) 4 goals by 2014 - Answer inform clinical practice, interconnect clinicians, personalize care, improve population health
inform clinical practice - Answer Examples of key informatics-based tools under the first goal include: electronic health records, clinical decision support systems and bar coded medication administration systems.
health tech forcing functions - Answer healthcare technology is designed to help prevent errors by reducing reliance on human memory.
- Answer When not well-designed, technology can actually promote error.
work arounds - Answer workaround as a bypass of a recognized problem in a system and flags the need for a genuine solution. I selected this image because one study identified 15 types of workarounds and >30 reasons associated with bar-coded med administration systems alone!
over reliance - Answer Over-reliance means assuming that computers know best: if your monitor looks like this, but your patient looks like this - you don't call a code, despite the rhythm strip!
desensitization - Answer An opposite but equally dangerous phenomenon is desensitization: when nobody checks the patient whose monitor looks like this because his alarm kept going off unnecessarily.
information conundrum - Answer type of attention deficit that is created when too much information is available
shared decision making tool: CHOICE - Answer Creating better Health Outcomes by Improving Communication about patients' Expectations is an example of a computerized support system that assists clinicians to acknowledge patient preferences when planning care.
The fourth and final goal of the HIT framework was to improve population health through better public health surveillance and the use of telehealth technology. - Answer
improved access to info improves health outcomes - Answer
teamwork and collaboration - Answer function effectively within nursing and interprofess teams fostering open communication mutual respect, and shared decision making to acheive quality patient care
acknowledge own potential, value persepectives, respect centrality of patient as core member of team
social justice - Answer distribution of advantages and disadvantages in a society.
provides access to what is good, personal responsibility
In short, a just culture ensures mutual respect between individuals and groups, no matter their rank or status. Moreover, a just culture is constantly evolving in order to dismantle systems of injustice.
how does unjust workplace develop - Answer systematic abuse of rank
history of unchallenged rankism
fear of freedom from opression
equality to equity - Answer Most efforts to address discrimination in healthcare and healthcare education has focused on equality. This refers to the idea that all individuals deserve the same access to goods, services, and fair treatment.
Equity, on the other hand, takes into account the long-lasting effects of discrimination, prejudice, and rankism. An equitable system is one that critically examines how some people, as a result of the systematic abuse of rank, will never have completely equal access to healthcare.
root cause of error - Answer communication >60%
orientation/training
patient assessment
most errors due to poor communication
patient safety - Answer avoidance prevention and amelioration of adverse outcomes stemming from health care
two challenge rule - Answer your responsibility to voice concern two times to ensure heard. take strongr course of action or use chain of command
