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Objectives: Differentiate among the types of nursing care delivery models. Describe the elements of decentralized decision making. Discuss ways in which a nurse manager supports staff involvement in a decentralized decisionmaking model.
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System focus Understanding of the environment of care Managing patient care Critical thinking Interdisciplinary communication Patient focused care Respect of patient rights, beliefs, wishes and values Advocacy Recognition of limitations and willingness to seek help Knowledge of the roles, responsibilities and functions of a nurse
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Nurse Executive
Who Are They?
Vice President or Director of
Nursing
that enables managers and staff to excel in better quality care and organization support.
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An Effective Leader is
Effective communicator Caring, understanding,
Consistent
Knowledgeable and
competent Role model Values participation Appropriate delegation Sets objectives and guides staff
Potter, P., Perry, A.G., Stockert, P.A., & Hall, A.M. (Eds.). (2013). Fundamentals of nursing. St.Louis, MO: Mosby
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Advantages
Collaborative Autonomy for team leader Decisions made at clinical level Nursing care conferences PCM able to manage unit issue High patient satisfaction RN plans care High amount of interdisciplinary collaboration Flexible Autonomous Collaborative Continuity of care Reduced errors
Disadvantages
RN is not as directly visible to patients Delegation takes time
All patient care done by RN Delegation allowed Direct work with patient/family/ interdisciplinary team RN responsible for caseload of patients Continuity of care providers RN assesses, develops POC, & provides interventions Lateral communication
Primary Nursing
Plan of care changes must be validated with primary RN Not cost saving
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Advantages
Collaborative Collaborative
Disadvantages
Primary Nursing
RNis is not asas directly RN not Autonomy for team visible to patients directly visible to leader Delegation takes time patient Low continuity High Autonomy for patients made at Decisions Flexible Plan of care satisfaction of care possible clinical level team leader changes must Nursing care takes conferences Autonomous Delegation be validated Delegation plans cost RN Decisions time PCM able tocare manage Decreased with primary allowed effectiveness unit issue Team leader made at Continuity of care Collaborative RN High amount All patient care done by RN High patient Low continuity of care develops plans of clinical level providers Delegation allowed satisfaction possible Direct work with of intercare & Continuity Decreased Not cost saving Direct work with RN plans care of cost patient/family/ disciplinary coordinates care High amount of effectiveness patient/family/ RN assesses, care Nursing care interdisciplinary collaboration interdisciplinary team interdisciplinary conferences develops POC, & collaboration team provides Hierarchical Reduced errors Plan of care changes RN responsible for caseload Flexible communication PCM able to interventions of patients Autonomous must be validated with manage unit Continuity of care providers Collaborative primary RN RN assesses, develops POC, Continuity of care Not cost saving issue & Lateral provides interventions Reduced errors communication Lateral communication
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Case Management
a collaborative process of assessment, planning,
facilitation, and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost-effective outcomes. (Case Management Society of America, 2010)
Decision Making
Decentralized management Decisions are made at the level of the staff All are included in the process of creating the best patient care available Greater collaboration Increased staff competency Increased staff motivation Increased staff satisfaction
Definitions:
Responsibility
Reflects ownership. These are the activities one is expected to perform Freedom of choice and the responsibility of the choices made. Power to direct others and make final decisions. Answerable to the actions taken.
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Autonomy
Authority
Accountability
1. Shared Governance
2. Nurse/Physician Collaborative Practice 3. Interdisciplinary Collaboration 4. Staff Communication 5. Staff Education
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1. Task
2. Circumstances 3. Person 4. Direction/Communication 5. Supervision/Evaluation
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Delegation Assessment
Assess
Match Communicate Listen
Feedback
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coordinates and links health care services to patients and their families while streamlining costs and maintaining quality is:
Primary nursing B. Total patient care C. Functional nursing D. Case management
A.
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coordinates and links health care services to patients and their families while streamlining costs and maintaining quality is:
Primary nursing B. Total patient care C. Functional nursing D. Case management
A.
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of evaluations?
A. B. C. D.
The nurse explains that side effects of the new blood pressure medication ordered for the patient. The nurse asks the patient to rate pain on a scale of 0 to 10 before administering the pain medication. After completing the teaching, the nurse observes the patient draw up and administer an insulin injection The nurse change the patient's leg ulcer dressing using aseptic technique.
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of evaluations?
A. B. C. D.
The nurse explains that side effects of the new blood pressure medication ordered for the patient. The nurse asks the patient to rate pain on a scale of 0 to 10 before administering the pain medication. After completing the teaching, the nurse observes the patient draw up and administer an insulin injection The nurse change the patient's leg ulcer dressing using aseptic technique.
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Objectives: Describe the five levels of communication and their uses in nursing (1) List nursing focus areas within the four phases of a nurse-client helping relationship. (1, 2, 4) Discuss and demonstrate effective communication techniques for clients at various developmental levels. (4, 7, 8)
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Levels of Communication:
Intrapersonal
Interpersonal Transpersonal
Small-group
Public
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Forms of Communication
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Preinteraction Phase
Orientation Phase
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Preinteraction Phase
Orientation Phase
Working Phase
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Preinteraction Phase
Orientation Phase
Working Phase
Termination Phase
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Professional Communication
Courtesy
Use of Names Trustworthiness
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Dysarthria, Muteness)
Listen attentively/patiently/avoid interruptions Avoid open ended questionsYes/No when possible Allow appropriate time Consult speech therapy Communication aids
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the patient to determine if the patient has understood him or her. This is what element of the communication process?
Referent B. Channel C. Environment D. Feedback
A.
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the patient to determine if the patient has understood him or her. This is what element of the communication process?
Referent B. Channel C. Environment D. Feedback
A.
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amputation of his leg. During the orientation phase of the relationship, what would you do?
Summarize what you have talked about in the previous sessions B. Review his medical record and talk to the other nurses about how he is reacting C. Explore his feelings about losing his leg D. Talk with him about his favorite hobbies
A.
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amputation of his leg. During the orientation phase of the relationship, what would you do?
Summarize what you have talked about in the previous sessions B. Review his medical record and talk to the other nurses about how he is reacting C. Explore his feelings about losing his leg D. Talk with him about his favorite hobbies
A.
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Objectives: Describe methods of interdisciplinary communication. Identify the purposes of the healthcare record and the legal guidelines associated with it. Discuss record keeping in healthcare and quality relates. Discuss the various forms of report; what is included and when they should be utilized.
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uneventfully.
permission
suicide.
Written or printed information that is recorded accurately, timely, and effectively to validate that an action attempted and the result.
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Rationale
Only objective/factual
yourself Avoid empty spaces Start: Date/Time. Real time End: Your name and title
observations and patient quotes. Black ink is easiest to read and copy You are accountable for whatever you chart Avoid others charting within your charting Provides sequencing Accountability
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Scenario
medical or previous surgical history, who fell 4 feet from a ladder two days ago, fracturing his right ankle. Mr. Trees has no medical allergies. Mr. Tree underwent surgical repair for his ankle and was transferred to your general medical/surgical nursing floor. Dr. Fix orders vital signs for every 8 hours with circulatory checks; activity orders are to transfer with one assist; saline IV flushed every 8 hours; Tylenol with codeine 500mg tablets, 2 tablets PO prn pain. The patient care assistant comes to you and says, Mr. Tree in room 3 is refusing to get out of bed because his ankle hurts him too much.
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Scenario Cont.
When you enter Mr. Trees room you note that he is
sitting ridged in bed with his eyes closed. When asked about pain Mr. Tree reports that his is currently having 9/10 sharp pain from his ankle to half way up his calf. As the primary nurse you begin to assess Mr. Trees leg. It is noted that Mr.Trees leg has no increased swelling, skin color is pink, warm and dry and has a <3 second capillary refill. Looking in Mr. Trees chart, you note that his last tylenol was taken 4 hours ago. Mr. Tree asks you, Cant I get something stronger? The tylenol is just not strong enough.
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Nursing Informatics
Science that integrates the sciences of nursing,
computers and information to manage and communicate data, information, and knowledge in nursing practice (American Nurses Association, 2008).
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System (CIS)
Nursing Information
Information System
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that support healthcare. rules and if___then statements Current Evidence based Updateable
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Security
Computerized charting increases security risks,
confidentiality risks, and privacy risks. Health Insurance Portability and Accountability Act (HIPPA) Personal Health Information (PHI) Proper disposal and protection of health information
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A patient asks for a copy of her medical record. The best response by the nurse is to:
State that only her family may read the record. B. Indicate that she has the right to read her record. C. Tell her that she is not allowed to read her record. D. Explain that only health are workers have access to her record.
A.
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A patient asks for a copy of her medical record. The best response by the nurse is to:
State that only her family may read the record. B. Indicate that she has the right to read her record. C. Tell her that she is not allowed to read her record. D. Explain that only health are workers have access to her record.
A.
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medical record and review the education that other nurses provided to the patient during an initial hospitalization and three subsequent clinic visits. This type of feature is most common in what type of record system?
Information technology B. Electronic health record C. Personal health information D. Administrative information system
A.
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medical record and review the education that other nurses provided to the patient during an initial hospitalization and three subsequent clinic visits. This type of feature is most common in what type of record system?
Information technology B. Electronic health record C. Personal health information D. Administrative information system
A.
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