Flashcards
nursey
Cards in this deck (166)
- 1True/False: AHPRA has warned nurses and midwives against publicly supporting anti-vaccination on social media. On what basis in law have they done this? (2)True.
Best current practice, National Law
Privacy and patient confidentiality in Code of Conduct NMBA - 2How many domains are there in the Code of Conduct4
- 3What is the first domain of the Codes of ConductPractice legally
- 4What is the main role of AHPRA? (4)Regulate health professions,
Oversee health profession boards,
Set out guidelines, policies, codes of conduct and
Respond to complaints - 5What is one way AHPRA carries out it's roles (3)Performs accrediting,
training and education,
issues Codes of Conduct - 6Are students registered with AHPRAYes
- 7State one basis on which a notification (complaint) may be made to AHPRA about a student (2)Notifiable conduct
Impairment (mental/physical) - 8On what basis is it mandatory for education providers to make a student notification to AHPRA (3)Notifiable conduct
Putting the public at risk
Capacity to perform and care as per reasonable standards of care - 9Which is more serious, professional misconduct or unsatisfactory professional conduct. Why?Unsatisfactory conduct.
It affects direct, primary care of a patient at the hospital “capacity to care” - 10State one factor that makes a professional and therapeutic relationship different from a personal oneYou hold professional responsibility for the other person
- 11Evidence indicates that person/woman-centred care can have positive health outcomes for patients/women. List oneLower hospital acquired infections
- 12True/False: Research has found that the vast majority (93%) of patients believe that a lack of empathy lowers the quality of careTrue
- 13What happens (ie what does the nurse/midwife do) in the pre-interaction phase of the therapeutic relationship“Collecting Cues”
Acquiring basic information about patient eg: in admission – age, sex, health conditions, medicaitons, mobility - 14In terms of professional boundaries/behaviour, what are the 3 zones on the continuum called?Underinvolvment
“Zone of Helpfulness”
Overinvolvement - 15In terms of the continuum of the professional relationship, what is the name of the zone in which the therapeutic relationship takes place?Zone of Helpfulness
- 16In terms of professional boundaries, what is a dual relationship?Having a personal relationship with a patient outside of work ie partner or friend
- 17In general, what types of gifts is it acceptable for a nurse/midwife to accept from a patient/woman or their carersChocolates, food, flowers to share with the whole nursing team
- 18What kind of behaviour is characterised by the zone of under-involvement? (2)Disinterest
Negligence - 19The appropriate response to a patient/woman who asks to be a Facebook (or other social media) friend with you is to…? (2)Decline politely,
explain the reason – risk of dual relationship, obligation to maintain professional boundaires. - 20SA health dignity in care program identifies 10 dignity principles: State one of them8. Engage peoples families and carers in the healthcare team
- 21In the ABCD of dignity, what does each letter stand for?Attitude
Behaviour
Communication
Dialogue - 22State one specific thing a nurse or midwife can do to address the “A” aspect of ABCDIdentify own pre-conceived notions
- 23Supply the missing word. Health information is regarded as … information, in the Privacy ActSensitive
- 24Complete the following sentence. The difference between privacy and confidentiality is that confidentiality relates to …Health records and personal details. Confidentiality is privacy of information
- 25What is the meaning of the term “primary purpose” as it is used in relation to the use of health information in the Commonwealth Privacy Act (2)Primary or main purpose is to care in a hospital setting and is the only time information should be accessed and used.
- 26In what circumstances, as stated in the Privacy Act, can sensitive information about a person be disclosed without their consent (4)Subpoenas,
court summons,
search warrants
to comply with police and courts - 27True/False: Patients own their health recordsNo.
- 28A nurse or midwife who leaves their handover notes on a patient/woman’s bedside table is breaching what aspect of the Health Records and Information Privacy ActBreach of confidentiality; that pertaining to security of storage of health records and sensitive information
- 29State one way in which critical thinking has been shown to have an impact on patient/woman safetyPositive patient outcomes. Poor clinical reasoning is a failure to detect deterioration in condition and is an adverse event.
- 30Which clinical reasoning error is this? “Tendency to focus or lock on to particular elements in the patient/woman’s situation early on and not adjusting this initial impression in response to later, relevant information”.Anchoring
- 31What is Stage 1 of the Clinical Reasoning CycleConsider the patient situation. It captures the overall picture, and patient scenario.
- 32Two midwives are discussing details of what happened during a recent birth as they walk down a hospital corridor. Which of the following is the most correct answer? a. This is likely to be a breach of privacy b. This is likely to be a breach of confidentiality c. This would only be a breach or privacy or confidentiality if other people are nearby d. This would only be a breach of privacy or confidentiality if they mention the woman’s name.B. Breach of confidentiality
- 33Under what circumstances can nurses and midwives legally have access to a patients/woman’s health information? (3)In order to carry out work duties
At work, for the main purpose of providing care or
when relevant allied health care providers require it. - 34You are a student on placement and have been allocated to a particular hospital ward. A close family friend of yours is admitted to the hospital, in a different ward, for surgery after having an accident. Their mother (who is away and can’t visit or contact them at the moment and is like a second mum to you) call syou in a lot of distress and asks you to look up their records to find out more information about the surgery, what is happening and how they are. Are you able to do this? (3)No. This is a breach of confidentiality.
It is accessing patient information for purposes not pertaining to providing direct care to the patient. It is not for the purpose of carrying out work duties.
It breaches Information Privacy Laws and NSW Health Policy. - 35What are the elements of non-verbal communication in the acronym SOLERSquarely face the other person and seated at the same height
Open posture
Lean-in if appropriate
Eye contact
Relaxed posture - 36In therapeutic communication, what does “attending” mean (3)Standing close to the patient’s bedside, paying attention to what they are saying and looking towards them as they speak
- 37Give one specific reason why therapeutic communication is important for quality of care and patient/woman safety (6)Nurses who communicate effectively are better able to
collect, share and validate assessment data,
think critically,
initiate interventions outcomes,
initiate change and prevent unsafe practice
Increase patient satisfaction with care
Build trust - 38In the Johari window, what is meant by the “blind area”. List 3 examplesAspects of self that one can’t see personally but others can
Being too loud
Attitude
Body language - 39Name two communication responses that are regarded as being barriers (or non-therapeutic) types of response (6)Excessive or inappropriate questioning
Patronising
Development/cognition
Giving common advice
Rejecting everything people say
False reassurance - 40Name two communication techniques that are appropriate to use when communicating with a person who has impaired hearing (6)Gesturing
Smiling
Low pitched voice
Talk clearly
Succinct sentences
Start with their name - 41hat is the first strategy in de-escalation (3)Acknowledge, prepare and be aware
- 42In the PREPARED acronym, what does the “A” stand forAcknowledge emotions and concerns of patients and their families
- 43Identify 3 specific elements that are involved in active listening (7)Being present
Paraphrasing
Nodding
SOLER acronym
Not interrupting
Take time to comprehend what was said
Using encouragement phrases to allow the person to continue - 44What are the three elements (or parts) of evidence based health care1. Best available Evidence (through research databases and journals)
2. Clinical Expertise (interpretation of data, consider context)
3. Patient values and preferences - 45What is a systematic review? (6)Condensed, comprehensive synthesis of existing literature.
Done used with intention that the public can read too.
Based on a pre-selected question
Done by a team (reduces bias) with a clear set of objectives
Has good quality studies with a pre-published protocol (methodology)
Translated into clinical practice decisions - 46On the hierarchy of evidence, what level are systematic reviews regarded as. What does this mean?Level 1 Evidence
Best available, current and least biased - 47What are two main characteristics of an RCT (Randomized Control Trial) (4)It has subjected and control groups.
Randomly distributed groups (distribution or allocation)
Comparison of treatment (intervention) which is given to one group compared with the control group.
Double-blind - 48Define incidence (3)Probability
Rate of new (or newly diagnosed) cases of a disease
Reported as the number of new cases occurring within a period of time (ie per monthly, per year) relative to population (ie per 100,000) - 49If 2 cases per day of MND are diagnosed what is the yearly per million incidence in Australia (assuming our population is 24 million)30 per 1 000 000 / year
365x2 = 720/year. 720 divided by 24 = 3. - 50Define prevalence (3)Likelihood, proportion, total number
Actual number of cases alive, with the disease either during a period of time (period of prevalence)
or at a a particular date in time (point of prevalence)
Depends on incidence
“Burden” - 51Define morbidity (3)Prevalence of a disease in % of the population
Departure, subjective or objective, from a state of physiological or psychological well-being.
Encompasses disease, injury and disability - 52Define mortality (3)Prevalence of death in a % of a population
Frequency of occurrence in define population at a specific interval
Crude mortality rate - 53Write a brief definition of safety (as it applies to patients/women in the health care system) (5)Maintaining physical and emotional wellbeing
Prevention of errors that lead to adverse events
Having systems and culturealy safety.
Transparency
Putting patient at the centre of care
Including physiological, emotional and cultural safety - 54What are the two main causes of adverse events that compromise patient/woman safetyPoor communication and poor teamwork
- 55What does James Reeson’s “Swiss Cheese” model of error (accidental causation) mean (4)Layers of organization to prevent errors
Reporting near misses and transparency and root cause (when, where, why, who, how admitted) analysis important
Reason for errors multi-faceted
Alternative is the domino effect - 56What does the acronym CUS stand forI’m CONCERNED that
I’m UNCOMFORTABLE with
This is not SAFE - 57What is REACHRecognise
Engaged
Act
Call
Help is on the way - 58State two characteristics of effective teams (10)Transparency, robust communication, mutual respect, accountability, common purpose, effective leadership, conflict resolution, flexibility, clear measurable goals, good teamwork
- 59State two characteristics of effective team leadership that contribute to patient/woman safetyClinical reasoning, encourage questions, good at briefing and debriefing, good delegation, calling for help, balance workloads, involve patient as integral part of team
- 60How would all out/check back have prevent the catastrophic error that occure to Grace WangUnclear and goal not common. Wanted intubation but it was not keeping her alive. Dying of hypoxia.
- 61What patient groups are particularly at risk of unsafe communication (6)Elderly,
non-english speaking,
children,
patients with developmental issues affecting speech,
drug affected patients - 62What are two factors that make patient/woman safety communication more difficult in the health care system? (10)Time constraints, lack of mutual respect, hierarchy, hospital culture, complexity of patient admission, fear, stress, anxiety, bullying, harassment and new technology
- 63What is health literacy (2)The ability to access, read, understand and use healthcare information in order to make appropriate health decisions and follow instructions for prevention, management and treatment.
- 64According to the ABS, how serious is the lack of health literacy in Australia (5)59% of Australians have difficulty with basic skills needed for health self-management. This leads to adverse events, poorer health outcomes and higher rates of hospitalisation, lower quality of life and increases health costs by 3-5%
- 65State 1 link between poor health literacy and health outcomes (3)Less likely to seek preventative measures such as immunisations and are more likely to miss appointments,
misuse medication,
fail to follow health care professional’s advice - 663 Domains of health literacy as defined by the CECReading – Qualitative, opinions and ideas
Numeracy – Quantitative, numbers and data
Wayfinding - Searching - 67In Rosenstock and Becker’s model of health beliefs, what is meant by ‘cues to action’ (2)Symptoms and signs
Internal – Fatigue, symptoms, perceived threat
External – Media, advice from healthcare professionals - 68In the Rosenstock and Becker’s model of health beliefs, the likelihood of a particular behaviour is X minus Y. What are X and Y (2)X = Perceived benefits, Y = Perceived barriers
Likelihood of behaviour is perceived benefits – perceived barriers - 69What stage of the TTM (Transtheoretical Model) of health behaviour change does the following description best fit “A person is not thinking about changing behaviour in the near future. May be uninformed or underinformed or misinformed. May have tried before and now believe change is hopeless. High levels of avoidance of thinking about the behaviour or need for change.”Precontemplation
- 70According to the TTM, the stages of health behaviour are cyclical. True/FalseTrue
- 71Name two therapeutic communication skills/techniques that are most likely to be helpful for someone in the Contemplation stage of the TTMOpen-ended questions and
Active listening - 72What is one evidence-based strategy that has been found to help improve health literacyTraining doctors and nurses to change the way they communicate with patients with low level literacy
- 73Practice question 1: What are the main purposes of a) the Code of Conduct for Nurses/Midwives and b) The ICN/ICM Codes of Ethics?a) Protect the public.
Establishes requirements for professional and safe practices of nurses
Sets out legal requirements, professional behaviour and conduct expectations
b) Guiding document for ethical decision-making
Provide a framework for standards of conduct - 74Practice question 2: Evaluate the professionalism of this post to social media using the NMBA Code of Conduct for Nurses, and identify 2 aspects of the code that were breached by the post. "A nurse posted the following comment on her social media page: “Can this shift be any longer? It started out with a waiting room full of nagging people that don’t seem to know what ‘emergency’ means. Then I had to deal with the drama of trying to transfer a 400 lbs. (no joke) intubated COPD patient down the hall to the ICU, those ICU nurses are such divas and I wasn’t in the mood for their whining. Anyone around ABC Hospital [name of hospital identified] want to save me with a drink to get me through the next 10 hours of my shift???Domain: Practice safely, effectively and collaboratively
Did not practice in accordance with NMBA Standards, Codes and Guidelines relating to social media, confidentiality and privacy
Breached clauses on bullying and harassment and confidentiality and privacy – breach or misuse of their privacy – refer to social media policy
Domain: Practice Legally, Obligations and Legal Behaviour
Breached National Privacy Laws by describing physical appearance that could be used to identify him. - 75a) Explain the difference between unsatisfactory professional conduct and professional misconduct.Unsatisfactory professional conduct OUTSIDE of work or profession. Below reasonable standard
Professional misconduct is during work as a nurse. Substantially below standards. Unfit to be in the profession - 76b) Between unsatisfactory professional conduct and professional misconduct, which has grounds for mandatory notification and which is voluntary?Under the National Law only registered health practitioners, employers and health education providers are required to report 'notifiable conduct' by making a mandatory notification.b) Which of these is grounds for mandatory notification and which is voluntary?
- 77On what grounds can students be the subject of an AHPRA notification?Practicing while intoxicated or influenced by drugs
Sexual misconduct
Place the public at harm due to impairment or due to unsatisfactory reasonable standards of care - 78Identify 2 specific actions you would take as a student to ensure that your social media posts accord with professional standards and codes.Maintain confidentiality both online and in any public setting – don’t discuss patients or stories about work online
Avoid potentially defamatory comments – avoid spreading rumours or complaining about a healthcare institution or other professionals
Maintain professional boundaries online – decline friend requests or dual relationships with patients and health care professionals - 79What are the differences between personal and professional values? b) name and explain 3 values that are espoused in the ICN/ICM Code of Ethics.Personal values pertain to values upheld and believed in personal life. Professional values are those which one must uphold when working in the nursing profession.
Accountability – for practice and maintaining competence
Good character – maintain standards that reflect well on the profession
Knowledge – Developing research based professional knowledge and use evidence-based practice
Justice – Creates positive environment, practice with safety, equitable social/economic working conditions
Honesty – Challenges unethical practices and settings - 80How do values and assumptions affect nurses/midwives behaviour? Identify AND explain one way in which nurses/midwives can ensure that their practice is not influenced by their personal values and assumptions in ways that impact negatively on patients/women?They can determine instinctive response to people or situations that we encounter causing a bad outcome ie: Religion, other nurses opinions during handover, personal views on people with lifestyle habits such as smoking, alcohol and obesity.
If uncomfortable with a situation or patient that may impact your capacity to care, inform the nurse manager so that the patient can be assigned to another nurse or you can be provided help.
Ask the patient questions, engage in a therapeutic relationship. Don’t judge them.
Staunton and Chiarellas Ethical decision making model - State the problem, Get the facts, Consider fundamental ethical principles, Consider problem from another perspective, Idenitfy ethical conflicts, Consider the law, Make an ethical evaluation - 81Define the ethical principles of autonomy, beneficence, non-maleficence and justice.Autonomy – The patients ability and legal right to make informed decisions about their own health care.
Beneficience – Doing good, being kind and acting with the intention to benefit the patient
Non-malificience – Do not intentionally inflict harm
Justice – Fairness in protection of rights and punishment of wrongs - 82What is the definition of impairment and b) identify 2 strategies that the Code of Conduct states that nurses must do in relation to this issue.Impairment – A state of being diminished, weakend or damaged, especially mentally, physically or cognitively.
Act to reduce fatigue and stress
Encourage and support colleagues to seek help if concerned they may be affecting their ability to practice safely
Seek expert, independent and objective help and advice if ill or impaired in ability to practice safely. - 83Explain what person/woman centred care meansSeeing the person behind the illness/injury; Treating the person with common courtesy and basic manners; showing fidelity, advocacy and autonomy, protecting their dignity
- 84Identify 4 nursing/midwifery behavours that are consistent with a PCC approach to the provision of care.Actively listening, advocating for and promoting the autonomy of the patient
Being friendly and courteous
Showing respect
Showing fidelity – checking up on the patient, seeing if they need anything - 85What are the three zones on the continuum of professional behaviours and identify 3 behaviours for each zone.Underinvolvement – Abandonment, disinterest, neglect
Therapeutic Relationship – Active-listening, upholds patient privacy, empathy
Overinvolvement – Professional sexual misconduct, physical assault, offering personal opinions - 86Identify 3 ways in which the practice of person centred or woman centred care is linked to patient/woman safety/better health outcomes.Evidence showing it positively affects patient health outcomes
Reduced mortality following myocardial infarction
Decreases rate of hospital acquired infections
Positive family and patient experience - 87Explain 2 strategies that the NMBA recommends that nurses/midwives use in order to ensure they remain within the zone which is therapeutic and safe for patients/women.Seek support and guidance from professionals.
Avoid dual relationships
Be clear with the patient about professional boundaries - 88State 3 aspects that make a therapeutic relationship different from a personal relationship.Involves compassion and ability to understand and respond to feelings of others.
Fundamental to effective communication
Patient satisfaction 52% higher when clinicians demonstrate empathy.
93% patients believe lack of empathy lowers the quality of care;
Patient adherence to treatment regimens in 62% higher when healthcare professionals undertake empathy training
(Virtual empathy museum) - 89Principle 4.1 of the NMBA Code of Conduct for Nurses/Midwives relates to professional boundaries. The Code states that “professional boundaries allow nurses/midwives, the person/woman and the person’s/woman's nominated partners, family and friends, to engage safely and effectively in professional relationships…” (NMBA, 2018. p.10). Identify and explain two actions that you would do as a student nurse/midwife to ensure that your practice is consistent with this principle of the code.Manage patients expectations – be clear about professional boundaries, prepare them for when the episode of care ends
Actively address indifference, omission, disengagement/lack of care and lack of respect = escalate issue with management to ensure safety of patient. - 90If you are given feedback about something that you were not aware that you do, what area of the Johari window would this be an example of?Blind area – Known to others but not known to self.
- 91What is the difference between privacy and confidentiality?Privacy pertains to the physical environment such as drawing a patients curtains, closing doors, being quiet, providing time alone, covering the patient.
Confidentiality pertains to the personal information gathered about the patient, it’s strict access and use in the health system. - 92What are the grounds (if any) on which it would be legally permissible for the Privacy Act to be breached?To comply with police investigations, subpoenas and courts summons.
- 93What specific actions should nurses and midwives take in their practice to ensure that patients/womans privacy is preserved as much as possible?Draw curtains, close doors, cover the patient, ask for consent before, during and after a procedure. Provide single sex bathrooms, avoid mixed gender accommodation. Inform the patient when they have a visitor. Knock on the door and introduce yourself when attending to the patient. Close the door when they are in the bathroom. Provide the patient alone time.
- 94What specific actions should nurse and midwives take in their practice to ensure that patients/women's confidentiality is preserved as much as possible?Access and use the patient’s information only at work for the primary purpose of caring for the patient.
Discuss the patients personal information with them in a private room – door closed, curtains drawn.
Don’t discuss patients in common areas with other healthcare professionals or others if it is not for the primary purpose of caring for the patient.
Don’t post information about patients or stories online.
Log off computers after using them.
Don’t leave hardcopies of patients charts or personal information out laying in common areas or in their room. - 95Explain (using specific examples) how privacy and dignity in health care are related.People feel dignified (treated with respect, as someone of value and worth) when their physical privacy and confidentiality is upheld and treated with high importance.
- 96How is health information defined under the commonwealth Privacy Act?Personal and clinical information relating to the individual. It includes name, address, contact details, date of birth, physical/mental disability, information relating to donation of human tissue and genetic information.
- 97Under what circumstances can nurses and midwives legally access patients'/womens' health information?In the work-place during work hours for the primary purpose of caring for that patient.
- 98A in ABCD explain and exampleA – The ATTITUDE a nurse has towards the patient and providing them care. It is helpful to identify your own pre-conceived notions, practice self-awareness and seek feedback from the patient and other professionals (pay attention to the Johani Window concept of blindspots)
- 99B in ABCD explain and exampleBehaviour – Undertaking your role as a nurse with kindness and respect. Utilise SOLER and simple gestures such as a smile, introducing yourself, help the patient put their shoes on, provide a glass of water, draw curtains and close doors.
- 100C in ABCD explain and exampleCommunication – The exchange of timely, sensitive and difficult information with a patient. Example: Invite the person to have someone from their support network present when complex or difficult information will be discussed.
- 101D in ABCD explain and exampleDialogue – Acknowledge personhood, get to know the patient, ask questions. Example: Validate their personhood with a statement such as “This must be frightening for you”. Ask “At this time in your life, what are things that are most important to you, or concern you the most?”
- 102Clinical reasoning cycle is Stage 1 Consider... Consists ofStage 1 Consider the Patient Scenario
Describe and list facts
context
objects or
people - 103Clinical reasoning cycle Stage 2 Review... Consists ofStage 2: Review Current Information
Handover reports
patient history
charts
investigation results
previous nursing/medical assessments - 104Clinical reasoning cycle Stage 2 Gather... Consists ofStage 2: Gather New Information
Undertake patient assessment
Example: skin, nutrition, mobility - 105Clinical reasoning cycle Stage 2 Recall... Consists ofStage 2: Recall Knowledge
Physiology
pathophysiology
pharmacology
epidemiology
therapeutics
context of care
ethics
law - 106Explain the links between clinical reasoning and patient/woman safetyClinical Reasoning is the skills that enable the nurse to use scientific data and reasoning to arrive at the safest option for the patient.
- 107Define AnchoringFixating or relying too much on one initial piece of information
EXAMPLE: A patient presents with dizziness and pallor and the nurse provides water assuming it is dehydration without performing vital observations which could indicate other reasons for the patients signs. - 108Define Unpacking principleFailure to elicit all relevant information (unpacking) in establishing a differential diagnosis
EXAMPLE: A patient limits providing all health history information during initial assessment or a nurse fails to note all health history information provided. - 109Define Premature closureAccepting a diagnosis before it has been fully verified.
EXAMPLE: Assisting a person who collapses outside on a hot day with water, believing their collapse was due to dehydration when it is later found their collapse was due to a low blood glucose level. - 110Define Ascertainment biasUsing a poor cross-section when conducting a study where some members of the intended population are less likely to be included than others.
EXAMPLE: A disease study intended to be nation-wide is limited to being conducted in major metropolitan areas due to time and expense restraints therefore not including data from rural areas. - 111Define Statistical biasThe expected result is different to the true results of the parameters being investigated.
EXAMPLE: Hoping for a particular result and then the results show a different one. - 112Define Psych Out ErrorGuessing
EXAMPLE: A student nurse guesses what is causing a patients signs and symptoms because they have limited knowledge on physiology, pathophysiology and lack experience. - 113Define Overconfidence biasBelieving you know more than you actually do.
EXAMPLE: A student doesn’t study for end of semester exam because they received full marks in a class quiz and assumed this mark was indicative of their knowledge of the entire course content. - 114Define Confirmation biasSearching and interpreting data to fit knowledge or an opinion one already has.
EXAMPLE: Cherry-picking studies from a database that suggest a particular treatment for a disease when there are systematic reviews and other literature that suggest best-practice is something else. - 115Define Diagnostic MomentumRelying on old diagnoses
EXAMPLE: A patient presents with bilateral oedema of the legs. The patient complains of pain and swelling in the left calf but due to the initial diagnoses, the nurse overlooks the possibility of a blood clot. - 116Define Fundamental Attribution ErrorPerceiving a problem with someone is an ‘inner’ problem rather than considering environmental factors
EXAMPLE: Perceiving a patient with a drug dependence is of bad character without considering social, emotional and psychological factors. - 117What is non-verbal communication and why is that important?Communication by means of body language and personal appearance – gestures, movements, facial expressions, use of touch, physical posture and gait.
Good personal appearance shows professionalism
Posture and gait that is slow, open, calm and upright shows attentiveness and interest
Facial expressions that are relaxed, smiling and include eye contact show convey friendliness, attentiveness and competence
Gestures such as open palms, touch on the shoulder/knee convey empathy and calmness. - 118Explain each element of SOLER and how SOLER contributes to the idea of attending. Squarely face the other person, seated at the same heightDemonstrates to the patient your whole body is focused at them.
At the same height conveys that you see the patient as your equal and don’t look down on them. - 119Explain each element of SOLER and how SOLER contributes to the idea of attending. Open postureConveys you are trustworthy and have nothing to hide
Conveys you are calm and not closed off from the patient out of fear or disinterest - 120Explain each element of SOLER and how SOLER contributes to the idea of attending. Lean-in if appropriateConveys you are interested in hearing what the patient has to say
Lets the patient know they don’t need to yell for you to listen - 121Explain each element of SOLER and how SOLER contributes to the idea of attending. Eye contactConveys to the patient you have their undivided attention
Shows you aren’t distracted by other people or things in the room - 122Explain each element of SOLER and how SOLER contributes to the idea of attending. Relaxed postureConveys you accepting of the patient, not angry or fearful
Conveys you aren’t in a rush to leave the patient
Conveys you are confident and competent to provide safe and quality care - 123Give examples of responses which would be classed as giving false reassurance and and explain why they are barriers to TC.“Everything will be okay.”
Dismissive of the patient’s legitimate fears and concerns
Discourages the patient from expressing fear and concern in future
“It won’t hurt.”
Dismissive of individual pain thresholds
Conveys you will pass judgement if they feel pain
Discourages the patient from speaking up when they feel pain
“It’s easy.”
Dismissive of patients’ idea of what is an easy and hard task
Conveys you will pass judgement if they find the task hard
Discourages the patient from communicating when they are struggling with a task and need help.
Are all subjective phrases. What the patient defines as “everything”, “okay”, “hurt” and “easy” can differ from what the nurse believes them to mean. This makes the nurse and hospital legally liable if and when the patient’s outcomes differ from what their concepts of these words mean. - 124Give examples of responses which would be classed as and giving common advice/personal opinion and explain why they are barriers to TC.“I personally don’t like Doctor XYZ because …”
Conveys doubt in the patients decision-making ability to choose their healthcare professional
“I personally think that… ”
Conveys you will pass judgement if the patient’s opinion differs from yours
The patient may pass judgment on the nurse and be unwilling to provide important information
The patient may lose trust in the nurse
“I read online that…”
Confuses the patient by conflicting and undermining the advice the patient receives from their healthcare professionals.
Raises mistrust in the patients mind about the competence of their current healthcare providers and validity of their current care
Mistrust leads to the patient withholding or delaying communicating important information.
May lead the patient to not follow through with advice from their healthcare professionals. - 125Identify and explain two strategies you would use to de-esclate a situation where a patient/woman or their relative/carer becomes agitated or angry.PREPARED
Ask close and open questions to obtain further information
Empathise
Provide a safe and secure environment
Sit at the same level
Validate
Provide choices
Suggest a plan of action - 126For nurses: explain what a) non-verbal therapeutic communication techniques you would use in a situation where a older patient who was recently diagnosed with a terminal illness tell you that he wants to get it all over with and die.For non-verbal communication to convey respect, empathy and validate their beliefs I would utilise
SOLER – Sit squarely at the patient, Open-posture, Lean-in, Eye-contact and Relaxed Posture.
Therapeutic touch – light touch on shoulder or knee or hold hand if appropriate
Nod when they are talking and
Provide silence - 127For nurses: explain what you would actually say and why in a situation where a older patient who was recently diagnosed with a terminal illness tell you that he wants to get it all over with and die.For verbal communication to provide privacy, validate their belief and show empathy I would
Actively listen
Ask open-ended questions, close-ended questions and probing questions
Gesturing phrases such as “Right.” “Okay.” “Wow.” “Really?” “Of course” “Mm/Ah” “I can see”
Utilise PREPARE - 128Give examples for phrases you would use in P of PREPAREPrepare for the discussion
“Can I close the door so we can have a chat?”
Offer the patient a cup of tea or coffee
Paraphrase what the patient says back to them to confirm I understand - 129Give examples of phrases to use in the R of PREPARERelate to the person
“I can only imagine what it feels like”
“I can see your point”
“I might have the same feelings if I were in a similar situation.” - 130Example phrases to use in E of PREPAREElicit patient and caregiver preferences
“Would you be willing to have a chat with me about it?”
“Is there anyone you’d be willing to talk with about how your feeling?”
“What can I do for you?” - 131Example phrases to use in 2nd P of PREPAREProvide information tailored to the needs of the patient and their family
“You don’t have to discuss this with me if that’s not what you want.” - 132Example phrases to use in A of PREPARE“I can see why you would feel that way.”
“I can only imagine what it must to be in your situation.”
“I’m here for you” - 133Example phrases to use in 2nd R of PREPARERealistic hope
“I’m not going to lie to you and say everything will be ok.”
Explore realistic goals and day to day coping methods
“How can we make today easier for you.” - 134Example phrases for 2nd E of PREPAREEncourage questions and further discussion
“I’m here for you.”
“Don’t hesitate to call for me if you want to talk to someone.”
“If there’s anyone else you’d like to talk to please let me know.” - 135When we say to people when they are upset or distressed "its Ok everthing will be all right", what non therapeutic technique (barrier to communication) is this called? Why is it thought to be unhelpful?False reassurance
Dismisses the patient’s legitimate emotions and concerns
Conveys passing judgement
Exacerbate situation – exacerbate emotions and feelings of being alone in their situation
Less likely to open up and communicate back to their healthcare professional
Leads to lower healthcare outcomes - 136Explain how a person or woman centred approach to care improves patient/women safetyMaintains physical and emotional wellbeing of the patient
Prevents errors and thus the number of adverse events
Centred around having systems and fostering a culture of safety
Emphasises transparency
Puts the patient at the centre of care, including psychological, emotional and cultural safety - 137What are the main factors that compromise patient/woman safety (ie contribute to error) in the health care system?Poor communication
Lack of teamwork
Inadequate check systems
Clinical Reasoning Errors - 138How does the "swiss cheese" model explain how errors happen and also help in their prevention?Layers of an organisation to prevent errors
Reporting near misses, transparency and analysing the root cause of a problem (going back to when, where, why, who, how) - 139How do CUS contribute to patient/woman safety in the prevention of error?CUS provides communication framework that encourages healthcare professionals and patients/women to speak up when they feel CONCERNED, UNCOMFORTABLE or when something feels UNSAFE
- 140How does call/out check back contribute to patient/woman safety in the prevention of error?Strategy used to communicate important and critical information to inform all team members simultaneously during emergent situations such as CPR announcement.
- 141How do REACH and TOP 5 contribute to patient/woman safe communication and hence to patient/woman safety?Recognise
Engaged
Act
Call
Help is on the way
Encourages patients/women and their caregivers/family members to signal when they need help and escalate concerns with staff about worrying changes in a patient’s condition. - 142In the Lewis Blackman case, when Lewis' blood pressure dropped to undetectable levels, instead of seeing this as an immediate life-threatening emergency, the nurses involved in his care decided that this was due to faulty equipment. So instead of immediately escalating this to call for an emergency response they tried to measure his BP using multiple (I think it was 12) different machines and/or cuffs. What kind of clinical reasoning error was this?Collect cues/information - Recall knowledge – Failure to refer back to knowledge of physiology of heart and blood pressure. Blood pressure that is not palpable indicates significant low blood volume. Low blood volume with no external bleeding indicates internal bleed.
Process information – After trying 2nd or 3rd machine, trying appropriate fitting cuff, attempting manual blood pressure reading, should process lack of reading not due to blood pressure equipment.
Take Action – Failure to escalate or consider alternative action to trying different equipment.
Evaluate – Did not properly evaluate using different equipment as ineffective. Continued attempting same action. - 143How can improved clinical reasoning help reduce errors in health care and improve patient/woman safety?Provides a framework that is informed and scientifically based.
Uses intuition and logic, based on knowledge, skills and experience
Constantly re-evaluating, self-correcting and striving to improve - 144What is a systematic review and why are they regarded as Level 1 (best available) evidence?Condensed, comprehensive synthesis of existing literature
Done with intention the public can read it too.
Is based on a pre-selected question
Done by a team (to reduce bias)
Has a clear set of objectives
Includes good quality studies with a pre-published protocol (methodology
Translated into clinical practice decisions – best practice - 145What type of research did James Lind do?The role of Vitamin C in seamens diets to reduce scurvy.
- 146What aspects distinguish a study as being quantitativeAim is to quantify data and generalize results from a sample to the population of interest
Used numerical comparison and is reported in form of statistics - 147What aspects distinguish a study as being qualitativeAim is to gain understanding of underlying reasons and motivations
Unstructured and subjective with theme identified by users
Reported in nonnumerical form, explores language and ideas of subjects - 148Explain what evidence based practice is, including the three elements (aspects) that it is composed of.Clinical Expertise and Experience
Patient/Woman Preferences
Best Evidence from Research - 149Issues with translating research into practiceCommon barriers include
Time constraints
Confidence in critical appraisal skills
Authority to change practice
Organisational structure and support
Access to resources and equipment - 150Define each of the determinants of health (social, biological, economic and environmental) and give an example of each.Social – Neighbourhood conditions and communities, education, gender, ethnicity, culture, social support networks, participation with governmental processes, exclusion,
Biological - Hereditary conditions, diet and lifestyle, addiction, stress
Economic – Income, employment and working conditions, affordability of healthcare and insurance, affordability of housing and resources of healthy food and water.
Environmental – Polution, neighbourhood conditions, housing, access to clean water and sewerage, access to heat and shelter. - 151What is meant by the social gradient (as it relates to health inequality)?Adults living in most socioeconomically disadvantaged areas more likely to be obese, smoke, be inactive, have high blood pressure and have higher risk of harm from alcohol
- 152Explain using principles of social health determinants and the social gradient why it is not helpful to blame people for their poor health.A form of bias where blame lies solely on individual’s inherent character and motivation without addressing external root causes of behaviour or negative health outcomes.
Exacerbates persons feeling of isolation in dealing with their health condition. They are then likely to delay or withhold important information or not adhere to a healthcare professional’s advice on prevention, treatment and management of conditions. - 153What is the difference between incidence and prevalence?Incidence
Probability of developing disease
Only includes new cases
Requires follow up of individuals in a population to identify new cases
Does not depend on duration of illness
Preferred measure when studying cause and effect
Prevalence
Probability of already having disease
Includes both new and old cases
Does not require follow-up
Depends on duration of disease (long duration increases prevalence) - 154What is primary preventionVaccinations
Screening
Health education and support
Community awareness and advertisement campaigns
Targets risk factors leading to injury and disease (safety belt laws, vaccinations),
Targeted at entire population - 155What is primary careBasic health care
Non-emergency situations
Seeing primary health care provider – General Practitioner for advise - 156What is primary health careComplex health care
Specialist for expert opinion or surgical/other intervention
Includes hospitalisation, surgery, rehabilitation
Treatment of disease, illness or injury - 157What is health promotion?Build healthy public policy
Re-orient health services
Develop personal skills
Strengthen community action
Create supportive environments - 158Why is health promotion and illness prevention regarded as being an important part of primary health care?Reduces costs to healthcare system
Reduces incidence of disease/illness
Reduces prevalence of disease/illness reaching advanced stage
Reduces comorbidity and mortality rates - 159Explain in your own words what 'culture' is and how this impacts on people's values and beliefs about health and illness.Culture can be described as a pattern of basic assumptions invented, discovered or developed by a given group and taught to new members as the correct way to perceive, think and feel
Culture influences a persons’ sick role emotion, coping, attitude towards health or health problem lifestyle and behaviours - diet, exercise, health-related behaviours
Communication of illness to family or friends or to seek out healthcare professionals
Perception and trust of healthcare professionals and advice – determines likelihood of preventing, treating and managing an illness, disease or injury. - 160What is the difference between cultural awareness and cultural safety?Cultural AWARENESS
Recognising own culture and behaviour different from others
Accept differences
Cultural SAFETY
Preferences of patient take predominant role
Adjust thinking and behaviour to effectively work with those from different culture - 161What is ethnocentrism and how does this relate to nurses/midwives developing culturally aware practice?Viewing an individual from another culture through the lens of your own culture’s standards and rules
Being mindful of difference in culture allows the nurse to
Differentiate own values and preferences from patient’s needs and preferences
Allows the nurse to identify and address needs and preferences to individual
Address cultural determinants of health
Address cultural barriers individual has in seeking, receiving and adhering to healthcare - 162What specific actions from a nurse or midwife would help support a person in this stage?Discuss risk for not changing and benefits of changing – pros and cons – barriers and rewards
Research where they can do physical activities around home and community
Suggest small incremental changes - 163A person wants to lose weight and improve their fitness. What behaviours would you expect to see from this person if they are in the contemplation stage of the TT model of behaviour change?Considering activity but not committing
Gathering information
Intends to take action in next 6 months
Weighing up pros and cons - 164Does low health literacy increase the cost to the health care system, if so how?3-5% increase cost
- 165What is health literacy and according to the ABS about how many Australians have low health literacy?The ability to access, read, understand and use healthcare information in order to make appropriate health decisions for ones own health and follow advise from healthcare professionals.
59% - 166Given that nurses and midwives are expected to provide person/woman centred care already, why is cultural safety still important? [this is another way of explaining how they are similar and different]. Be able to use aspects of Principles 3.1 and 3.2 of Code of Conduct in developing an answer to this. (treat this as a 5 mark slightly longer answer type question that you would do for section C of the exam)Understand and acknowledge historic factors impacting aboriginal people and challenging pre-conceived notions helps recognise how they influence interactions and care and avoid bias
Recognise importance of family and community to help advocate and facilitate access to culturally safe health services
Show respect but be mindful that patient determines what is safe and respectful
Be inclusive and support rights
Understand and accept external and historical factors affecting health
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- Nursing Flashcards on nursey, created by cat dog on 29/05/2019.
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