FNP finals

• Evidence-based practice (EBP)


  The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research

  
• Evidence-based nursing


  When the nurse can integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care
• There is a gap between what practitioners know and how they care for their patients
• EBP


  Attempts to bridge the gap using review of current published research, practitioner's own experience and the patient's preferences to facilitate how practitioners make evidence informed decisions to deliver quality and cost effective care
• Components of EBP


  • Best research evidence
  • Clinical expertise
  • Patient values and preferences

  
• Steps to establish EBP

  1. Cultivate a spirit of inquiry

  2. Ask clinical questions

  3. Search for the best evidence

  4. Critically appraise the evidence

  5. Integrate the evidence with clinical expertise and client/family preferences and values

  6. Implement and evaluate the outcomes of the intervention

  
• Research is considered to provide the highest level of evidence
• The use of research findings to guide decision making in patient care is not new to the nursing profession
• Nurses use quantitative and qualitative research approaches that originated from various philosophical perspectives to contribute to evidence-informed nursing practice
• The PICO format is a strategy for stating the problem to be answered in nursing research
• Evidence-based practice or evidence-based nursing


  Involves clinical decision making using a variety of sources of evidence modified for use in specific settings and for individual clients
• Change in practice requires assessing the need for change; locating and analyzing the best evidence; designing, implementing, and evaluating the practice change; and integrating and maintaining change
• In today's EBP environment, ALL nurses need to be well-informed consumers of research and able to serve as effective research team members
• Nurses are required to be continuously involved in generating and publishing evidence in order to improve patient care and expand nursing's knowledge base
• Communication


  A process in which people affect one through the exchange of information
• Therapeutic communication


  Interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information

  
• Differences between therapeutic and social communication


  • Therapeutic: Focus on helping patients, relies on patient's disclosures, confidentiality must be respected
  • Social: Equal and mutual disclosure, focus on meeting personal needs, may be for friendship
• Therapeutic nurse-patient relationship


  A helping relationship that's based on mutual trust and respect, nurturing of faith and hope, being sensitive to self and others, and assisting with gratification of your patient's physical, emotional, and spiritual needs through your knowledge and skill
• Goals of therapeutic communication


  • Establish therapeutic nurse-client relationship
  • Identify the most important client concern
  • Assess the client's perception of the problem
  • Facilitate the client's expression of emotions
  • Teach client and family necessary self-care skills
  • Recognize client's needs
  • Implement interventions to address the client's needs
  • Guide client toward identifying a plan of action

  
• Three essential purposes of therapeutic communication


  • Allow the client to express thoughts, feelings, behaviors, and life experiences in a meaningful way
  • Understand the significance of the client's problems and the role the client and significant others play
  • Assist in the identification and resolution processes of the client's health-related behaviors
• Characteristics of therapeutic communication (GEPCART)


  • Genuineness
  • Empathy
  • Positive regard
  • Clarity
  • Assertiveness
  • Responsibility
  • Trustworthiness
• Therapeutic communication as related to the nursing process and phases of the therapeutic nurse-client relationship

  Not provided

  
• Individuals who need effective communication skills


  • Supervisors
  • Employees
  • Physicians
  • Colleagues
• Effective communication skills


  • Learning how to say no
  • Expressing opinions & feelings
  • Stating beliefs
  • Initiating conversations
  • Maintaining eye contact when speaking
• Responsibility language


  "I" vs "you" e.g. "I feel responsible for the medication error", "I feel hurt when you say that to me" vs. "Jonah made me angry", "He made me hit him"
• Responsible communication


  Involves accountability for outcome of professional interactions
• Responsible communication


  Ensures clients receive and interpret messages correctly; strengthens growth in others
• Responsible language


  "I" statements
• Trustworthiness


  • Responsible and dependable
  • Keeps commitments & promises
  • Consistent in approach & response to clients
  • Respects client's privacy, rights, and the need for confidentiality
• Clients need to know they can rely on the nurse


  In order to build trust
• Self-disclosure


  Opening up oneself to others; an effective therapeutic skill if fully understood & used carefully
• Self-disclosure


  Use requires that the nurse and client have a therapeutic relationship
• Self-disclosure


  Rationale: for client to self-disclose in return
• Self-disclosure


  Nurses reveal carefully selected thoughts, feelings, and life events to demonstrate to the client that they understand what the client is going through
• Self-disclosure


  Always for the client's benefit & not for the nurse
• Proxemics


  The study of people spacing, and including studies of crowding and privacy; study of how space is used in human interaction
• Proxemic zones


  • Intimate: 0 – 18 inches
  • Personal: 18 inches to 4 ft
  • Social: 4 to 12 feet
  • Public: 12 feet and beyond
• SOLER


  • Sit squarely facing the patient
  • Observe an open posture
  • Lean toward the patient
  • Establish eye contact
  • Relax
• Professional boundary violations


  • Keeping secrets
  • Spending free time with the patient
  • Sharing intimate information
  • Displaying favoritism
  • Giving personalized gifts
• Medical records are referred to as health records or client records