1.  What is patient centered care
•	Levels of patient centered-care
o	3 levels
o	six core elements (pg 294)
•	Care Competency: providing patient-centered care.
•	Self management of care, health, literacy, patient and family education.
•	Nurse-patient communication and interaction
•	Core coordination: plan of care, critical thinking, clinical reasoning & judgement, delegation.
•	Culture, diversity, & disparities. 
•	Patient advocacy.
o	Factors impacting care
•	Access
•	Insurance
•	Transportation
•	Literacy
o	Includes multiple factors and activities- all aimed at making the patient the center of care. 
	2. patient advocacy
•	Nursing standards support advocacy, consumerism
•	Nurses need to recognize patient values, preferences
o	Should lead to increased collaboration
o	Patient, provider, nurse
	3. clinical reasoning versus critical thinking
•	critical thinking- requires nurse to generate and examine questions and problems, use evaluate evidence. 
•	Clinical reasoning- “practitioners” ability to assess patient problems or needs and analyze data to accurately identify and frame problems within the context of the individual patients environment.
o	Information seeking- in-depth searching and asking quesitons
o	Reflecting-reviewing experiences broadly, evaluationg, examining cognitive process.
o	Assigning meaning-identifying relevant data and interpreting
o	Problem solving, predicting, planning- knowing what to do next and making decisions
o	Applying novel contexts
4. Health literacy (how many people actually understand health information)
•	90million Americans (almost half of all adults) have difficulty understanding and using health information. 
•	The degree to which individuals have the capacity to obtain, process, and understand basic information and services need to making appropriate decisions regarding their health.
	5. Delegation of patient teaching (must be RN to RN)
five rights
o	task
o	circumstance
o	person
o	direction/communication
o	supervision
•	Delegation principles
o	Responsibility, accountability
o	Delegating components of care
o	Delegation based on RN’s judgment
o	Individualized communication
•	Levels of Patient Health Status
o	Independent- only a few nursing needs
o	Partially dependant- partial bath
o	Fully dependent- bed ridden, total care
	6. What does working in INTERDISCIPLINARY teams mean, and what is it?
•	Emphasizes collective action and in-depth collaboration.
o	What individuals can do to contribute  to the joint team plan and initiatives.
o	Membership-all necessary disciplines
o	Sources of information-patients and/or significant others provide information along with members of the disciplines
o	Leadership-leadership and membership vary depending on the situation
o	Decision making-all members work together to come up with both alternative solutions and final decisions
o	Focus of care- collaboration to see the bigger picture. 
•	Cooperate, collaborate, communicate, integrate care in teams to ensure care is continuous and reliable
•	QSEN- essential features of competency
	7. Barriers to communication/listening
•	anxiety and stress
•	interruptions
•	too many tasks to do
•	fatigue and hunger
•	lack of self-esteem
•	anger
•	reaction from the past
•	confusing message. 
	8. What is collaboration and coordination?
•	Collaboration- all people involved are listened to and that the decisions are developed together. 
o	Open communication
o	Team members comfortable expressing opinions.
o	Work relationships with physicians 
o	Improving work relationships
•	Coordination- working to see that the pieces and activities fit together and flow as they should, this helps to meet desired patient outcomes. 
o	Interconnectedness with collaboration
o	Nurse as the “anchor” to patient
	9. what is research and what is applied research?
•	Research- deseigned to broaden  the base of knowledge rather than solve an immediate problem
•	Applied research- designed to find solutions to a practical problem.
o	Nurses typically more involved 
	10. What is "health systems" research?
	
	11. What is a conceptual framework? (within the context of research)
	12.  What is an experimental design?
•	377
	13.  What is an IRB and the purpose of it?
•	Institutional Review Board-A committee that reviews research before it is conducted to ensure that the study is conducted ethically. 
•	After experiences of abuse in research efforts were instituted to prevent further problems.
•	Mandated to review all research involving human subjects in institutions that receive federal funds
•	Purpose is to protect subjects in institutions that outweigh potential benefits. 
	14. What is evidenced based practice?
•	The use of EBP in nursing leads to more effective decision making to guide the use of limited resources, control costs, and improve quality. 
o	EBP review involves looking for evidence 
•	Evidence of research results
•	Evidence from patient’s assessment and other sources
•	Evidence from clinical expertise
•	Evidence from information about patient preferences and values. 
	15. What is a PICO question?
•	The PICO question be part of every search for evidence to improve practice. 
o	The goal is to ask searchable and answerable question. 
o	P-Patient-needs to be specific- describing the population such as age, gender, diagnosis, ethnicity
o	I-intervention- can be related to prognostic factors, risk behaviors, exposure to disease, or clinical intervention or treatment
o	C-Comparison- can be with another treatment or no treatment.
o	O-Outcome- what will it be, such as risk of disease, complication, or side effect, or adverse outcome.
	16.  Medication erros and patient deaths (it is in the book)
•	Preventable adverse events-medication errors
	
	17.  Major complications that happen while in the hospital are no longer covered by medicare/medicaid.  These are things that should in theory never really happen with appropriate supervision and standards of care (falls, pressure sores, wrong procedure/person, etc).  Know some examples of these
	
	18.  What is the defintion of an error and what is a sentinel event?
•	Error- the failure of a planned action to be completed as intended or the use of the wrong plan to achieve an aim; errors are directly related outcomes.
•	Sentinel event-an event that had a negative patient outcome (unexpected death, serious physical or psychological injury, or serious risk). A root cause analysis or a systematic review of the event is conducted to assess the process, not the individual staff who were involved; blame is not the goal, but rather the prevention of further events. 
	19.  What is the focus of the ANA program "Handle with Care"?
•	est. Sep 2003
•	Goal is to develop and implement a proactive, multifaceted plan to promote the issue of safe patient handling and the prevention of musculoskeletal disorders among nurses in the U.S..
o	Seeks to educate and advocate and facilitate change from traditional practices of manual patient handling to emerging technology-orientated methods. 
	20. Quality improvement/CQI
•	requires that health professionals be clear about what they are trying to accomplish, what changes they can make that will result in an improvement , and how they will know that the improvement, and occurred. 
•	
	21. Informatics, what is it, how can it benefit the health care system, what are some barriers?
•	How technology is used to prevent errors and improve care. 
o	Email, websites
o	Quailty improvements
o	Insurers
o	Key terms related to informatics
•	Can lead to safe, quality care
•	Nurse need to take active role
•	Information sharing and coordination of care
	22.  What kind of documentation should you expect to see in a patient care file?  Is it subjective (by the nurse) or objective? Consent forms, nurses notes, MD and other disciplinary notes etc..
•	Documentation is objective information
•	Pg 446.
	23.  What is the benefit of bar coding in the informatic system?
•	Systems select the medication based on the order and prepare it in single doses for the patient
o	The bar code is on the packaged dose. 
o	This code can then be compared with the bar code on the patients identification band using a handheld device
o	System decreases errors and supports 5 rights of medication administration.
	24.  Where is the future of technology in healthcare?
•	Nanotechnology-microscopic technology on the order of one billionth of a meter- will likely impact diagnosis and treatment of many diseases and condition. 
•	Wearable computing- a computer can be worn and interactions with the user are based on the context of the situation. 
o	With heads-up displays, embedded sensors in fabrics, unobtrusive input devices, personal wireless local area networks.
	25.  What is a HIPPA violation?
•	Discussing patient information in public places, calling a patient work or home and leaving a message that reveals information is prohibited. 
	26.  What is the nursing application status in the US?  Is it increasing or decreasing?
	27. What is the average age of the RN workforce?
•	47-50
	28. What generation is known as workaholics?
•	Baby-boomers
	29.  Review generational differences in general and be able to apply that to nursing with respect to values/technology, etc..
•	traditional silent, or mature generation-1930-1940
o	committed to nursing and HCO for which they worked. 
o	Believed in hierarchy as important part of the organization
•	Baby boomers- 1943-1960
o	Largest number of nurses active
o	Female dominated
o	Work independently, accept authority, cause few problems, feel loyalty is an important work value, less able to cope with new technology
o	Consensus leadership, are competitive, focused on material gain. 
•	Generation X- 1960-1980
o	Motivational, receptive, and positive. 
o	Good communicators and team players, they have good people skills, and they are approachable and supportive. 
o	Do not demonstrate loyalty to their employers- costly for healthcare system and has impact on quality of care. 
o	Not workaholics- want personal life. 
•	Generation Y- 1980-2000
o	Values achievement, social issues, and diversity
o	Dependent on technology
o	Multitask and are optimistic
o	Trust in centralized authority
o	Change is normal for them.
	
	30 What are the costs associated with nursing turnover?
•	Advertising and recruitment
•	Vacancy costs (paying agency nurses, overtime, closed beds, and hospital diversion when emergency department must be closed)
•	Hiring (review and processing of applicants)
•	Orientation and training
•	Decreased productivity (loss of staff who know routines)
•	Termination ( processing of termination)
•	Potential patient errors; compromised quality of care
•	Poor work environment and culture; dissatisfaction; distrust
•	Loss of organizational knowledge (loss of staff who know the history of the organization and processes)
	You should also be prepared to discuss the nursing shortage and strategies to combat this issues
	You should also be prepared to discuss delegation, interdisciplanary care, and the 5 rights of delegation
	And lastly......
	You should be prepared to discuss conflict resolution