ACCNS-AG flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Tanner's clinical judgment model

Four phases - noticing, interpreting, responding, and reflecting. Reflection occurs both in-action during the event and on-action afterward, guiding subsequent clinical decisions.

Shock index

Heart rate divided by systolic blood pressure. A value above 0.9 suggests occult hypoperfusion and is associated with worse outcomes in trauma and hemorrhage.

qSOFA criteria

One point each for respiratory rate 22/min or higher, altered mentation, and systolic blood pressure 100 mm Hg or lower; a score of 2 or more prompts sepsis evaluation.

Sepsis-3 definition

Suspected infection plus an acute increase in SOFA score of at least 2 points. Septic shock adds vasopressor need for MAP 65 or higher and lactate above 2 mmol/L.

Moral distress

The experience of knowing the ethically appropriate action but being prevented from taking it by institutional, hierarchical, or resource constraints. It can cause burnout and moral injury.

Patient Self-Determination Act

A 1990 federal law requiring Medicare- and Medicaid-funded hospitals to inform patients of their right to make advance directives and to document whether one exists.

Withholding versus withdrawing

Ethically equivalent when the goals of care are the same; neither is homicide, and both require valid consent or surrogate authority plus documentation.

Informed consent elements

Capacity, disclosure of risks, benefits and alternatives, comprehension, and voluntariness. The provider obtains consent; the nurse verifies, witnesses, and answers questions within scope.

Swanson's caring processes

Maintaining belief, knowing, being with, doing for, and enabling. The model defines caring as a nurturing way of relating to a valued other.

CAM-ICU

A delirium screening tool assessing acute onset or fluctuating course, inattention, altered level of consciousness, and disorganized thinking. Positive if features 1 and 2 plus 3 or 4 are present.

CPOT

Critical-Care Pain Observation Tool scores 0 to 8 across facial expression, body movements, muscle tension, and ventilator compliance or vocalization; a score above 2 indicates pain.

Family-centered care

An approach treating the family as both care recipient and partner, supporting family presence, information sharing, and participation in decision-making within unit policy.

TeamSTEPPS core skills

Communication, leadership, situation monitoring, and mutual support. These teamwork competencies reduce error and are taught with tools such as SBAR, huddles, and check-backs.

Two-challenge rule

A safety assertion stated twice; if the concern is still not addressed, the nurse escalates through the chain of command rather than remaining silent.

I-PASS handoff

Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by the receiver. Standardized structure reduces handoff omissions.

Closed-loop communication

The sender gives an order, the receiver repeats it back, and the sender confirms accuracy. This verifies that the message was heard correctly.

Donabedian framework

Evaluates quality through Structure (resources), Process (what is done), and Outcome (results). It is the basis for many quality measures and accreditation standards.

Just culture

A framework distinguishing human error (console), at-risk behavior (coach), and reckless behavior (sanction), encouraging reporting while retaining accountability.

Swiss cheese model

Reason's model holds that harm occurs when holes in multiple defensive layers align; it shifts analysis from individual blame to system defenses.

PDSA cycle

Plan, Do, Study, Act. Small rapid tests of change are used to learn and adapt before spreading an intervention across a system.

Cultural competence model

Campinha-Bacote's five constructs: cultural awareness, knowledge, skill, encounters, and desire, with desire described as the driving force for becoming culturally competent.

CLAS standards

National standards from the Office of Minority Health for culturally and linguistically appropriate services, including language access, governance, and communication of rights.

LEARN model

Listen, Explain, Acknowledge, Recommend, and Negotiate. It guides cross-cultural clinical negotiation of a plan that fits the patient's explanatory model.

Teach-back method

The clinician asks the patient to explain information in their own words, confirming understanding and revealing gaps rather than asking yes-or-no questions.

Andragogy principles

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

Benner's novice to expert

Five levels - novice, advanced beginner, competent, proficient, expert - describing how nurses move from rule-governed practice to intuitive, context-aware performance.

Kirkpatrick evaluation levels

Reaction, learning, behavior, and results. Education is evaluated from learner satisfaction through transfer to practice and organizational outcomes.

SMART objectives

Specific, measurable, achievable, relevant, and time-bound. Objectives written this way can be evaluated and give learners clear expectations.

PICOT format

Population, Intervention, Comparison, Outcome, and Time frame. It converts a clinical uncertainty into a searchable, answerable evidence-based practice question.

Number needed to treat

One divided by the absolute risk reduction. It states how many patients must be treated for one additional patient to benefit.

Sensitivity and specificity

Sensitivity is true positives divided by all people with disease; specificity is true negatives divided by all people without disease. Both are prevalence-independent.

GRADE certainty ratings

High, moderate, low, or very low certainty, downgraded for risk of bias, inconsistency, indirectness, imprecision, and publication bias, and upgraded for large effects.