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Clinical Decision Making


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Primary prevention
Health education, risk assessment, immunization
Seconday prevention
Screening surveys, self-exam, care to prevent illness complications
Tertiary prevention
Referring a person with drug addiction to a support group.
Teaching a person with emphysema the early signs of infection and what to do.
Precontemplation (client)
Denies problem, may feel hopeless
Contemplation (client)
Acknowledges problem, researches solutions, not ready to commit to action
Preparation (client)
Plans to take action, makes final adjustments before beginning change
Action (client)
Modifies behavior and surroundings
Maintenance (client)
Integrates new behavior into lifestyle
Termination (client)
Copes without fear or relapse
Precontemplation (nurse)
Assess readiness, discuss pros/cons
Contemplation (nurse)
Assist client in performing self-evaluation (why do I..?), reflect future without behavior
Preparation (nurse)
Support and guidance; set a date, create action plan, public declaration of change, enlist family/friends' support
Action (nurse)
Positive reinforcement, substitution of healthy responses, modify environment, plan rewards
Maintenance (nurse)
Encourage identification of relapse signs, positive reinfforcement
Termination (nurse)
New self-image, no temptation, solid confidence
Decision balance
Cost-Benefit written exercise whereby the patient, with nurse faciliation lists the perceived 'benefits' of a behavior and the deleterious effects.
Motivational interviewing
Elicit responses
-Ex: Instead of 'you should quit smoking to get rid of that cough' change to 'how has your cough been affecting you lately' or 'do you see any connection between smoking and your complaint about coughing?'
-Ex. You seem concerned about the fact your mother died of a heart disease...have you considered what you may want to do to reduce your risk?
Freely chosen, enduring beliefs about the worth of something or person
(Opinions) Interpretations or conclusions that people accept as true (may or may not actually be true)
Doing good for others
Right to make one's own decisions
-The study of morality
-The practices or beliefs of a certain group
-The expected standards of moral behavior of a certain group as defined by their formal ethical code
Private, personal standards of right and wrong r/t conduct, character, and attitude. Can be related to law and/or religion, but not necessarily. Tend to respond to these situations with clarifiers (i.e., ought, should, right, wrong, good, bad).
Consequence-based (teleological)
Utilitarianism (greatest good for greatest #)
Principles-based (deontological)
Emphasizes individual rights, duties, obligations
Relationships-based (caring) theories
Actions are judged according to a perspective of caring and responsibility (common good)
'Do no harm'
'Doing good'
Being faithful to agreements
Truth telling
Code of Ethics (ANA)
'The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations or social or economic status, personal attributes, or the nature of health problems.'
Constitution of the United States
Laws enacted by a legislative body- statutes to regulate- Nurse Practice Acts
Enforcement of statutes- State Board of Nursing
Common law
Body of principles derived from court-decisions- following precedent- previous cases
Nurse Practice Acts
Legislated state law defining legal scope of practice; differentiates roles LPN, RN
False imprisonment
Restraints, seclusion
False communication or communication with disregard for truth- injures a person's reputation (written=libel; spoken=slander)
Attempt; battery (willful touching)
False information with intention that it will be acted on by another person
Invasion of privacy
Breach of confidentiality
Failure to do something (omission) or doing something (commission)-> "wrong" results
Negligence as applied to a professional person.
Informed consent
A client's agreement to accept a medical or surgical procedure/treatment after disclosure by physician and understanding of "complete" information about it.
Requires that health information about clients be secured so that only those with the right and need to access the info can
Available to people with disabilities and people 65 years and older. Provides insurance to hospitalization, home care, and hospital care. Clients must pay 20% share of a government-approved charge.
A federal public assistance program paid out of general taxes to people who require financial assistance, such as people with low incomes.
Third-party reimbursement because the insurance company pays either the entire bill or, more often, 80% of the costs of health care services.
-Individual plan
-Plan of employer, union, student association, etc.
Health Maintenance Organization (HMO)
A group health care agency that provides basic and supplemental health maintenance and treatment services to voluntary enrollees. A fee is set without regard to the amount or kind of services provided.
Preferred Provider Organizaton (PPO)
A group of physicians and perhaps a health care agency (often hospitals) that provide an insurance company or employer with health services at a discounted rate.
Preferred Provider Arrangement (PPA)
Contracted with individual health care providers.
Independent Practice Association (IPA)
Provides care in offices, client pays a fixed payment and that goes to the provider.
Physician/Hospital Organization (PHO)
Joint ventures between a group of private practice physicians and a hospital.
Primary nursing
A system in which one nurse is responsible for total care of a number of clients 24 hours a day, 7 days a week. It is a method of providing comprehensive, individualized, and consistent care.
Functional nursing
Method that focuses on the jobs to be completed (e.g. bed making, temperature measurement).
Case management
A range of models for integrating health care services for individuals or groups.
Critical pathways
An interdisciplinary plan or tool that specifies interdisciplinary assessments, interventions, treatments, and outcomes for health-related conditions across a time line.
Patient-focused care
A delivery model that brings all services and care providers to the clients.
Managed care
A health care system whose goals are to provide cost-effective, quality care that focuses on decreased costs and improved outcomes for groups of clients.

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