ACCNS-AG cheat sheet

Tanner's clinical judgment model has four phases - noticing, interpreting, responding, and reflecting - with reflection occurring both in-action and on-action.

MAP = (SBP + 2 × DBP) ÷ 3; a MAP of at least 65 mm Hg is the usual adult resuscitation target in septic shock.

qSOFA assigns 1 point each for respiratory rate ≥22/min, altered mentation, and systolic BP ≤100 mm Hg; a score ≥2 prompts further sepsis evaluation.

Shock index = heart rate ÷ systolic blood pressure; a value above 0.9 suggests occult hypoperfusion in adults.

Sepsis-3 defines sepsis as suspected infection plus an acute SOFA increase of ≥2 points; septic shock adds vasopressor requirement for MAP ≥65 mm Hg and lactate >2 mmol/L despite adequate fluids.

SBAR structures handoff as Situation, Background, Assessment, Recommendation; it reduces omission of critical information.

The nursing process sequence is assessment, diagnosis, planning, implementation, evaluation; evaluation loops back into reassessment rather than ending the cycle.

The primary survey order is airway, breathing, circulation, disability, exposure; immediate life threats are corrected before the secondary survey.

Early hypothesis generation followed by deliberate data testing characterizes strong diagnostic reasoning; premature closure and anchoring are common cognitive errors.

Core ethical principles are respect for autonomy, beneficence, nonmaleficence, and justice; veracity and fidelity are supporting principles.

Moral distress occurs when a nurse knows the ethically correct action but institutional, hierarchical, or resource constraints prevent it.

The Patient Self-Determination Act (1990) requires Medicare- and Medicaid-funded hospitals to inform patients of advance directive rights and document whether one exists.

Withholding and withdrawing life-sustaining treatment are considered ethically equivalent when the goals of care are the same.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, comprehension, and voluntariness; the provider obtains consent and the nurse verifies and witnesses it.

Ethics consultation is indicated for value conflict among stakeholders, an unclear or contested decision-maker, or disagreement about goals of care.

HIPAA permits disclosure of protected health information without authorization for treatment, payment, operations, and legally mandated reporting.

Mandatory reporting duties include suspected abuse or neglect of children, older adults, and dependent adults, plus specified communicable diseases.

The surrogate decision-making hierarchy typically runs court-appointed guardian, spouse, adult children, parents, then siblings; the exact order is state-specific.

Watson's Theory of Human Caring is organized around ten caritas processes, including developing and sustaining a helping-trusting, authentic caring relationship.

Swanson's theory of caring comprises five processes: maintaining belief, knowing, being with, doing for, and enabling.

The ABCDEF bundle: Assess and treat pain, Both spontaneous awakening and breathing trials, Choice of analgesia and sedation, Delirium monitoring, Early mobility, Family engagement.

CAM-ICU screens four delirium features: acute onset or fluctuating course, inattention, altered level of consciousness, and disorganized thinking.

CPOT scores 0–8 using facial expression, body movements, muscle tension, and ventilator compliance or vocalization; a score above 2 indicates pain.

BPS scores 3–12 from facial expression, upper-limb movement, and ventilator compliance; a score above 5 indicates pain.

Presence is being physically and psychologically available to the patient; it is a distinct nursing intervention rather than mere proximity.

Family-centered care treats the family as both care recipient and partner, supporting presence, information sharing, and participation within unit policy.

Therapeutic communication uses open-ended questions, reflection, paraphrasing, and silence; false reassurance, blocking, and advice-giving are nontherapeutic.

TeamSTEPPS core skills are communication, leadership, situation monitoring, and mutual support.

CUS - Concerned, Uncomfortable, Safety issue - is a graded assertion tool for escalating a safety concern.

The two-challenge rule requires voicing a safety concern twice, then escalating through the chain of command if it remains unaddressed.

I-PASS handoff: Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by the receiver.

Thomas-Kilmann conflict modes are competing, collaborating, compromising, avoiding, and accommodating; collaborating is preferred when stakes are high and time allows.

Closed-loop communication requires the receiver to repeat back an order and the sender to confirm the read-back is accurate.

Shared governance distributes decision-making through councils such as unit practice, quality, education, and research councils.

Interprofessional rounds that include nursing, pharmacy, medicine, and allied health improve goal alignment and reduce length of stay.

Chain of command escalation proceeds from unit leadership to department leadership to house supervisor or administrator when patient safety is at risk.

The Donabedian framework evaluates quality through Structure (resources), Process (what is done), and Outcome (results).

Reason's Swiss cheese model attributes harm to alignment of holes across multiple defensive layers rather than a single error.

Just culture distinguishes human error (console), at-risk behavior (coach), and reckless behavior (sanction).

PDSA means Plan, Do, Study, Act; small rapid cycles test a change before it is spread across a system.

Root cause analysis is retrospective and used after sentinel events; FMEA is prospective and ranks failure modes by severity × occurrence × detectability.

Lewin's change model is unfreezing, moving, refreezing; Kotter's eight-step model begins with establishing a sense of urgency.

A clinical microsystem is the smallest functional unit that provides care; the macrosystem is the larger organization and environment in which it operates.

HFMEA prioritizes failure modes with a hazard score of severity × probability, sometimes including detectability, and addresses the highest scores first.

Nursing-sensitive indicators include falls, pressure injuries, CAUTI, CLABSI, and nurse staffing or skill mix.

Campinha-Bacote's cultural competence model has five constructs: cultural awareness, knowledge, skill, encounters, and desire; desire is the driving force.

The CLAS standards from the Office of Minority Health provide national guidance for culturally and linguistically appropriate services.

Title VI requires recipients of federal funds to provide meaningful language access, including qualified interpreters at no cost to the patient.

Use trained medical interpreters rather than family members or minors for clinical communication, and document interpreter use.

Teach-back confirms understanding by asking the patient to explain instructions in their own words.

Health literacy is the ability to obtain, process, and understand health information; plain-language materials at or below a 6th-grade reading level are recommended.

The LEARN model is Listen, Explain, Acknowledge, Recommend, Negotiate.

Social determinants of health include economic stability, education, social and community context, health and healthcare, and neighborhood and built environment.

Implicit bias is an unconscious association that can influence triage acuity, pain treatment, and discharge planning decisions.

Knowles' andragogy holds that adult learners are self-directed, experience-rich, problem-centered, and motivated by relevance, respect, and immediate application.

Benner's novice-to-expert model has five levels: novice, advanced beginner, competent, proficient, expert.

Revised Bloom's taxonomy levels are remember, understand, apply, analyze, evaluate, and create.

Kirkpatrick's four evaluation levels are reaction, learning, behavior, and results.

SMART objectives are specific, measurable, achievable, relevant, and time-bound.

Deliberate practice requires repeated performance with immediate, specific feedback and progressively increasing difficulty.

VARK describes visual, auditory, read/write, and kinesthetic preferences; matching instruction to preference has weak supporting evidence.

Simulation-based education follows prebriefing, scenario, and debriefing; debriefing produces most of the learning.

Competency validation uses direct observation, return demonstration, and standardized checklists with established inter-rater reliability.

PICOT = Population, Intervention, Comparison, Outcome, and Time frame.

Evidence hierarchy: systematic review or meta-analysis > randomized controlled trial > cohort > case-control > cross-sectional > case series > expert opinion.

NNT = 1 ÷ absolute risk reduction; NNH = 1 ÷ absolute risk increase.

Sensitivity = true positives ÷ all people with disease; specificity = true negatives ÷ all people without disease.

PPV = true positives ÷ all positive results; PPV rises as disease prevalence rises.

A 95% confidence interval contains the true effect in 95% of repeated samples; for ratio measures, an interval excluding 1 corresponds to p < 0.05.

Common EBP models include Iowa, Johns Hopkins, Stetler, ACE Star, and ARCC; each guides question formation, evidence appraisal, translation, and evaluation.

GRADE rates certainty as high, moderate, low, or very low, downgrading for risk of bias, inconsistency, indirectness, imprecision, and publication bias.

IRB review categories are exempt, expedited, and full board; consent must disclose purpose, risks, benefits, alternatives, and the right to withdraw.