1
Q
What is IOMs 5 core competencies for heath care professionals?
A
- Provide patient centered care
- Work in interdisciplinary or interprofessional teams
- Employ evidence based practice
- Apply quality improvement
- Utilize informatics
2
Q
This is a independent, not-for-profit organization that accredits hospitals
A
The joint commission (JCAHO)
3
Q
What does TJC set as far as standards for hospitals?
A
They set high standards for hospitals to increase quality care
4
Q
Hospitals are responsible for reporting data on their performance based on the:
A
National Quality Improvement Goals
5
Q
What is The Joint Commissions’ (TJC) definition of Quality Improvement?
A
An approach to the continuous study and improvement of the process of providing health care services to meet the needs of patients and others and inform health care policy
6
Q
What led to an increased awareness of U.S. medical errors?
A
a report issued in November 1999 by the U. S. Institute of Medicine (IOM)
7
Q
__________ Americans die every year from medical errors
A
44,000 (could be as high as 98,000)
8
Q
More people die from medication errors than:
A
- MVA
- Breast cancer
- AIDS
9
Q
What are serious problems with healthcare?
A
- safety
- quality
- waste
- inefficiency
10
Q
This report focused on patient safety issues
A
To Err is human (1999)
11
Q
This report focused on additional quality problems
A
Crossing the quality chasm (2001)
12
Q
This report combined patient and nurse safety issues:
A
Keeping Patients Safe: Transforming the Work Environment for Nurses (2004)
13
Q
What happens when errors occur and why is it so important?
A
- increased cost for pt/hospital and insurance co.
- decrease bonuses or incentives for nurses
- decreased trust from pts
14
Q
Medicare and medicaid will no longer pay for:
A
- preventable complications
- hospital acquired
complications (HAC) - serious reportable events
(SREs)
15
Q
Use _________ to discuss safety and errors:
A
common language
16
Q
We need to have ______ standards
A
data
17
Q
What kind of systems should be in place?
A
reporting systems
18
Q
The 8th leading cause of death in a hospital is:
A
medication errors
19
Q
What is included on the official do not use lists for acronyms?
A
- U/u (units)
- IU (international unit)
- QD (daily)
- QOD (every other day)
- Trailing zeros (write X mg)
- MS (morphine sulfate)
- MSO4 (magnesium sulfate)
20
Q
What does “pc” mean?
A
after meals
21
Q
What does “ac” mean?
A
before meals
22
Q
What does “HS” mean?
A
hour sleep
23
Q
What are some clinical safety terms?
A
- Safety
- Error
- Adverse event (no allergies noted but pt breaks out in rash after medication; not fatal and not expected)/Side effect (less serious; unexpected side effect)
- Misuse (pt allergic to medication but was given the medication)
- Overuse (pt has been given too much of the medication or too many meds)
- Underuse (pt doesn’t have insurance so a inferior medication is used)
- Near miss (could have happened but was caught)
- Sentinel event (an event that should not happen)
- Root cause analysis (understanding what the real issue is)
24
Q
The IOM recommends using _______ to evaluate why patients are harmed by medical care:
A
PSRS
25
What are other patient safety reporting systems that can be used?
- PSN
| - ICUSRS
26
What does the incident report system used at UTMB capture?
- Adverse events
- Near misses
- Sentinel events
27
PSN reported data is ________ and _______
confidential; privileged
28
What questions are addressed during the root cause analysis matrix?
- What happened?
- Why did it happen?
- What were the most proximate factors?
- What systems & processes underlie those proximate factors?
29
What is the first step in the process of medication?
Health care provider prescribes the medication (enters order into computer)
30
What is the second step in the process of medication?
Order goes to pharmacy (errors can occur here)
31
What is the third step in the process of medication?
Pharmacist reviews/approves order & Phar Tech prepares the medication
32
What is the fourth step in the process of medication?
Pharm tech sends medication via pneumonic tub or delivers the medication to the patients medication bend or Pyxis
33
What is the fifth step in the process of medication?
Nurse reviews order and confirms validity before administering the medication
34
What is HCAPS?
hospital report card
35
What is quality improvement focused on?
improving work processes to improve patient outcomes and efficiency of health systems
36
The QI process begins at the:
staff level (magnet recognition program = the best of the best)
37
Quality improvement is a combination of:
QI and evidence based practice
38
What areas does QI analyze?
- operational
- quality
- satisfaction
39
What can we do to improve the quality of patient care?
- Look at the structure
- Look at the process
- Use various QI models/tools:
- Evaluate the outcomes
40
What is the plan, do, study, act (PDSA) model?
good for an issue that you have time to study and plan for (not life threatening)
41
What is the rapid improvement event model (RIE)?
this issue must be addressed immediately, no time is available to study or analyze changes must be made ASAP
42
The "plan" phase of the PDSA model allows for:
- capturing the problem or idea
- planning what you will change and predict for what the impact will be
- plan what information you will collect to measure whether the change has had an effect
43
The "do" phase of the PDSA model allows for:
- trying out the change on a small scale
| - collecting the information required to measure the change
44
The "act" phase of the PDSA model allows for:
- standardizing your improvement
- deciding whether to make further change
- planning how to improve on the original change made
45
The "study" phase of the PDSA model allows for:
- analyzing the information collected to understand the impact of the change
- comparing your analysis with the predictions from the plan stage
- summarizing what you have learned
46
How long does the RIE model allow you to fix the issue?
5 days
47
What are the team competency outcomes?
- knowledge
- attitude
- performance
48
What does knowledge within a team embody?
A shared mental model
49
What does attitudes within a team embody?
Mutual trust and team orientation
50
What is the two way dynamic interplay?
Interaction between the outcomes and skills is the basis for the team
51
What does the team leader do?
* Team Leader must be selected *
- Coordinates activities
- Share changes in information
- Gather all necessary resources
52
What are the different team events that occur?
- brief
- huddle
- debrief
53
What occurs during a brief?
A short planning session prior to start to:
- discuss team formation
- assign essential roles
- establish expectations and climate
- anticipate outcomes and contingencies
54
What is the aim of a huddle and what occurs during a huddle?
* problem solving *
- involves a ad hoc team to reestablish situation awareness
- assessing the need to adjust the plan
- reinforcing plans already in place
55
What occurs during a debrief?
- process improvement
| - improve team performance and effectiveness (after action review)
56
Example of a debrief would be:
after a code; assessing what went well and what areas could be improved to prepare for the next code
57
You should continue _________ what is happening within a team
scanning and assessing
58
What is a shared mental model?
Where all team members are on the same page
59
What is cross monitoring?
An error reduction strategy
60
What are the components of STEP?
- Status of patient
- Team members
- Environment
- Progress towards goal
61
What is the IM SAFE acronym used for?
used for nurses to keep themselves healthy
62
IM SAFE stands for:
```
I - illness
M - medication
S - stress
A - alcohol and drugs
F - fatigue
E - eating and elimination
```
63
What is the two challenge rule?
Where you can voice concern two times to ensure it has been heard
- The team member being challenged must acknowledge
- If outcome is not acceptable:
> take stronger course of
action (go up chain of
command)
- Empowerment (empowers both team members involved)
64
What is CUS?
It means STOP THE LINE if a safety breach is sensed or discovered:
- I am concerned
- I am uncomfortable
- This is a safety issue
65
The DESC script is:
a constructive approach for
| managing and resolving conflict
66
What does DESC stand for?
D: Describe the situation or behavior and provide data
E: Express your feelings or concerns
S: Suggest other alternatives and seek agreement
C: Consequences on team goals; strive for consensus
67
Collaboration is a:
- mutual solution for the best outcome (WIN WIN WIN)
> commitment to a
common mission
- meet goals without comprising relationships
*this is a process, not an event*
68
What does SBAR stand for?
- Situation (what is going on with the patient)
- Background (what is the clinical background or context)
- Assessment (what do I think the problem is)
- Recommendation (what would I do to correct it)
69
What is call out?
a communication tool used to communicate critical information
- informs team members simultaneously during emergent situations
- helps anticipate next steps
- directs responsibility to a specific individual
70
What is check back?
Process of employing closed loop communication to ensure that information conveyed by the sender is understood by the receiver as intended
71
What is a handoff?
Strategy designed to enhance information exchange during transitions in care (transfer of information) allowing for the opportunity to ask questions, clarify, and confirm
72
What are the components of a handoff?
* I PASS THE BATON*
- Introduction (introduce yourself, your role/job and pt)
- Patient (name, DOB, sex, loc)
- Assessment (chief complaint, VS, s/sx, dx)
- Situation (current status, code status, response to tx, etc)
- Safety concerns (critical lab values, allergies, alerts)
- Background (family history, co-morbidities, etc)
- Actions (actions taken and why)
- Timing (level of urgency/prioritization of actions)
- Ownership (who is responsible for pt including family)
- Next (anticipated changes, what is the plan)
73
TeamSTEPPS is comprised of four teachable-learnable
| skills:
- Leadership
- Situation Monitoring
- Mutual Support
- Communication
74
Delineates fundamentals such as team size, membership, leadership, composition,
identification and distribution
team structure
75
Ability to coordinate the activities of team members by ensuring team actions are understood, changes in information are shared, and that team members have the
necessary resources
leadership
76
Process of actively scanning and assessing situational elements to gain information, understanding, or maintain awareness to support functioning of the team
situation monitoring
77
Ability to anticipate and support other team
members’ needs through accurate knowledge
about their responsibilities and workload
mutual support
78
Process by which information is clearly and accurately exchanged among team members
communication
79
This is a tool for monitoring situations in the delivery of health care
STEP
80
Team members protect
| each other from ________:
work overload situations
81
Effective teams place all
offers and requests for
assistance in the context of
patient safety
82
Team members foster a
climate where it is expected
that assistance will be
actively __________
sought and offered
83
What is feedback?
Information provided for the purpose of improving team performance
84
Feedback should be:
Timely – given soon after the
target behavior has occurred
Respectful – focus on behaviors, not personal attributes
Specific – be specific about what behaviors need correcting
Directed towards improvement – provide directions for future
improvement
Considerate – consider a team member’s feelings and deliver negative information with fairness and respect
85
Assert a corrective action in a
| firm and respectful manner by:
- Making an opening
- Stating the concern
- Offering a solution
- Obtaining an agreement
86
A technique for communicating critical information that requires immediate attention and action concerning a patient’s condition
SBAR
87
```
This example of an incoming trauma is:
Leader: “Airway status?”
Resident: “Airway clear”
Leader: “Breath sounds?”
Resident: “Breath sounds
decreased on right”
Leader: “Blood pressure?”
Nurse: “BP is 96/62”
```
call out
88
What are the steps of a check back?
1. Sender initiates the message
2. Receiver accepts the message and
provides feedback
3. Sender double-checks to ensure that
the message was received
89
Doctor: “Give 25 mg Benadryl IV push”
Nurse: “25 mg Benadryl IV push”
Doctor: “That’s correct”
This is an example of a:
check back
90
What are some examples of transitions in care?
- shift changes
- physicians transferring complete responsibility
- patient transfers
91
Who creates the national patient safety goals?
TJC (revised every year)
92
How can we improve staff communication?
By reporting critical results of tests and diagnostic procedures in a timely manner
93
The hospital should have written procedures regarding:
- The definition of critical results
- By whom and to whom results should be reported
- Acceptable length of time between availability & reporting of results
94
When communicating SBAR, you must communicate:
- who you are?
- what unit you are on?
- who is the patient?
* give OBJECTIVE data *
95
When recording/documents medicines that patients are taking, you should:
- Compare new medicines to medicines patients taking now
- Patient education regarding medicines the patient should take at home
- Patient education regarding bringing up to date medicines at their visit
96
What is alarm fatigue (unsafe issue when looking at alarms)?
When the nurses have various alarms going off (NEVER SILENCE THEM OR TURN THEM OFF)
97
What organization requires employers to provide appropriate PPE for workers who could be exposed to blood or other infectious materials?
OSHA
98
What are the different types of precautions?
- Standard Precautions
- Contact Precautions
- Extended Contract Precautions
- Respiratory/Droplet Precautions
- Airborne Precautions
- Protective environment
99
What medical conditions fall under contact isolation?
- MRSA
- Major wound infections with drainage
- Herpes simplex
- Scabies
- Varicella zoster
100
Wha PPE should be worn under contact isolation?
- clean gloves
| - clean gown
101
Under extended contact isolation, how must you wash your hands?
for 20-30 seconds before/after pt contact
102
What conditions fall under extended precautions?
- C. Diff
- Bacillus anthracis
- Norovirus
103
What are some causes of C. Diff?
- Spore forming organism
- Antibiotics
- Exposure
104
What are some s/sx of C. Diff?
- Diarrhea (mild to colitis)
| - Distinct odor
105
What is the size of airborne droplets?
small droplets (3-5 microns)
106
What conditions fall under airborne precautions?
- TB
- Chicken pox (varicella)
- Measles (rubella)
107
Airborne precaution patients must be:
in a negative pressure room
108
Wha PPE should be worn under airborne isolation?
- fitted N95
- gloves (MMR)
- gowns (MMR)
109
What is the size of droplet precaution droplets?
large droplets (> 5 microns)
110
What conditions fall under droplet precautions?
- flu
| - bacterial meningitis
111
Wha PPE should be worn under droplet isolation?
- surgical mask if < 3 ft from the pt
112
How do you donn PPE?
* gather PPE and perform hand hygiene *
- gown
- mask
- goggles
- gloves
113
How do you doff PPE?
- gloves
- gown
- goggles
- mask
114
What are some multidrug resistant organisms?
- Methicillin resistant
- Staphylococcus aureas (MRSA)
- Clostridium difficile (C diff)
- Vancomycin resistant
enterococci (VRE)
- Carbapenem resistant
enterobacteriaceae (CRE)
115
Foley goes on the bed ______ not the bed _______
frame; rail
116
What diseases can be transmitted from a needle stick?
- Hep B and C
| - HIV
117
The braden scale is in regards to bed sores and on the braden scale, the lower the number:
the greater the risk
118
The braden scale covers:
- Sensory perception
- Moisture
- Physical activity
- Mobility
- Nutrition
- Friction & Shear
119
A score of <10 on a braden scale is:
very high risk
120
A score of 10-12 on a braden scale is:
high risk
121
A score of 13-14 on a braden scale is:
moderate risk
122
A score of 15-18 on a braden scale is:
mild risk
123
A score of 18+ on a braden scale is:
low risk
124
Where is the most likely spot for a bed sore?
buttocks (occipital bone)
heels
elbows
125
What are the risk factors for bed sores?
- Impaired sensory perception
- Impaired mobility
- Alteration in level of consciousness (LOC)
- Shear
- Friction
- Moisture
126
What are the pressure ulcer stages?
Stage I: Intact skin-non blanchable redness
Stage II: Partial thickness and skin loss (epi, dermis or both)
Stage III: Full thickness and skin loss with visible fat and tunneling may be present
Stage IV: Full thickness and skin loss with exposed bone, tendon and muscle
Unstageable: Full thickness with skin loss, slough and eschar
127
How often should you turn bed bound patients?
every 2 hours
128
Obtain an _________to redistribute the pressure over bony prominences
air mattress
129
Significant percentage of injuries in the hospital, nursing care centers, & at home related to _____
falls
130
How can we reduce the risk for falls?
- Implement fall risk reduction methods
| - Referral to physical therapy for assessment & possible therapy
131
What is the morse fall scale variables?
- history of falls
- secondary diagnosis
- ambulatory aid
- IV or IV access
- gait
- mental status
* high risk fall is a higher number *
132
A score of 0-24 on a morse fall scale means:
no risk for falls
133
A score of 25-45 on a morse fall scale means:
low to moderate risk for falls
| *implement standard fall interventions*
134
A score of 46+ on a morse fall scale means:
high risk *implement high risk fall precautions*
135
When is fall risk assessment done?
on admission and it does not change unless someone just had surgery and was given morphine
136
The single greatest risk for overexertion injuries in healthcare workers is the:
- manual lifting
- moving and repositioning of patients
- residents or clients (manual patient handling)
137
________ refers to the design of work tasks to best suit the capabilities of workers. In the case of patient handling, it involves the use of mechanical equipment and safety procedures to lift and move patients so that health care workers can avoid using manual exertions and thereby reduce their risk of injury. At the same time, patient handling ergonomics seeks to maximize the safety and comfort of patients during handling.
ergonomics
138
What is the number one incivility in nursing?
nurse bullying
139
The needs theory (Virginia Henderson):
assist the patient with activities until they recover or die
140
The self-care theory (Dorothea Orem):
the nurse prescribes and regulates the nursing system based on the patients self-care deficit
141
Roys adaptation model (Sister Callista Roy):
nursing as a humanistic discipline that emphasizes the persons adaptive or coping abilities
142
Transcultural nursing (Madeline Leininger):
viewed cultural differences and healthcare practices
143
Healthy People 2020 vision is:
A society in which all people live long, healthy
144
What is holistic healthcare?
- Patient centered care
| - Mind, Body, and Spirit
145
What does QSEN stand for?
Quality and Safety Education for Nurses
146
Health is a state of complete:
Mental, Physical, and Social Wellbeing
147
How is health and wellness measured globally?
by morbidity and mortality
148
______ is how frequent the disease occurs
morbidity
149
______ is the number of deaths from a disease
mortality
150
______ is the active state of being healthy
wellness
151
The Dunns' Model includes:
- Being
- Belonging
- Becoming
- Befitting
152
______ is the pathological changes to the structure or function of the body or mind:
Disease
153
_______ is the response of a person to the disease.
illness
154
What is illness and disease influenced by?
- self-perceptions
- others perceptions
- culture
- spiritual values and beliefs
155
This illness has a rapid onset and lasts a short time
acute illness
156
Chronic illness causes at least one or more of the following:
- Permanent change
- Causes or is caused by irreversible alterations in normal A&P
- Requires special patient education for rehabilitation
- Requires a long period of care and support
- Remission and exacerbation
157
What are the stages of illness behaviors?
Stage 1: Experiencing symptoms: Symptoms incompatible of ones own personal definition of health
Stage 2: Assuming the sick role: Defining oneself as sick
Stage 3: Assuming the dependent role: Accepting the diagnosis and treatment plan
Stage 4: Achieving recovery and rehabilitation
* family *
158
What is health equity?
Attainment of the highest level of health for everyone
159
What is health disparity?
Health difference closely linked to social, economic and or environmental disadvantage (vulnerable populations)
160
What are the social determinants of health?
Environment in which people are born, live, learn, worship, work, Play and age
161
What are things a person can change considered as?
modifiable
162
What things are considered nonmodifiable?
family history
163
_________ is behavior that exhibits a personal desire to increase well-being and health potential
health promotion
164
Primary health promotion is:
Secondary health promotion is:
Tertiary health promotion is:
1. prevention
2. screening
3. after the diagnosis with goal of rehabilitating to maximum level of function
165
The health belief model consist of:
- Perceived susceptibility to a disease
- Perceived seriousness of a disease
- Perceived benefits of action
- Self efficacy
166
The stages of the change model helps with:
addictions
167
________ is not thinking of a change; 4 r’s reluctance, rebellion, resignation, and rationalization
Precontemplation
168
_______ is starting to think about change
Contemplation
169
Determination/Commitment to action means:
a decision is made to change
170
________ is coexistence of different ethnic, biological sex, racial, socioeconomic groups within one social unit
Cultural Diversity
171
______ enables nurses to deliver care that is respectful and responsive to health beliefs, practices and linguistic needs of diverse patients. Critical to reducing health disparities and improving access to high quality health care
Cultural Respect
172
_______ is a shared system of beliefs, values, and behavioral expectations that provides a social structure for daily living.
Culture
173
_______ nursing is a subculture of a large health system culture
subculture
174
_____ when a culture migrates to a more dominant culture they may take on the culture of the dominant group
Cultural Assimilation
175
______ occurs when an individual is placed in a different culture that seem strange
Culture Shock
176
_____ is identification with a collective culture group based on heritage
Ethnicity
177
______ is based on physical characteristics
Race
178
What factors inhibit sensitivity?
- stereotyping
- cultural imposition
- cultural blindness
- culture conflict
- culture bias
179
____ is the belief that everyone should conform to your belief system
Cultural Imposition
180
_____Ignores differences and proceeds as if they don’t exist
Cultural Blindness
181
______ Occurs when people recognize the differences and ridicule others belief to make themselves more secure
Cultural Conflict
182
______ is judging others that are different from one's own beliefs
Cultural Bias
183
______ Some ethnic groups are more prone to specific diseases
Physiologic Variations
184
_____ predicts the response to pain
Culture
185
Some ethnic groups do not believe in:
mental health issues
186
What are some cultural influences on healthcare?
- Food and Nutrition
- Family Support
- Socioeconomic factors
- Health Disparities
187
______ is caused by dangerous agents:
natural illnesses
188
______ is caused by failure to follow Gods rules
Unnatural illnesses
189
In _______ care is sensitive to the needs of the individual
Cultural Competence
190
What does the ESFT model stand for?
- Explanatory Model of health and illness
- Social and environmental factors
- Fears and Concerns
- Therapeutic contracting
191
Why should nurses use the ESFT model?
to improve outcomes
192
______ is belief that one's own beliefs are superior
Ethnocentrisms
193
Nursing knowledge is based on which of the following? (Select all that apply.)
- nursing research
| - discipline-specific research
194
The horizontal bars of patient-centered care, interdisciplinary collaboration, evidence-based practice, quality improvement, informatics and safety in the ATI Helix of Success were significantly influenced by which of the following?
Quality and Safety Education for Nurses (QSEN)
195
The ability to predict client needs and anticipate changes in the health status of a client stems from knowledge of which of the following topics?
Physiology and pathophysiology
196
Match the learning strategies in the right column with its appropriate style of learning in the left column. In the space provided, place the letter that corresponds to the correct number. Note each style will be matched to two strategies. Click "Submit" when all the blanks are filled in.
```
Visual learner:
- place info. on a timeline
- organize notes in an outline
Auditory learner:
- use a tape recorder in class
- create songs or mnemonics
Tactile learner:
- practice skills in nursing lab
- develop models or displays
```
197
List and describe the five steps that should be taken to improve reading comprehension and retention.
1. skim
2. actively read
3. ask questions
4. stop and think
5. periodically review
198
Which of the following are essential strategies to effectively manage time? (Select all that apply.)
- Develop a written or electronic schedule.
- Allow time for personal rewards.
- Study at regular intervals.
199
Foundational knowledge is represented by which of the following types of thinking? (Select all that apply.)
- recall
| - comprehension
200
Which of the following statements describe what clinical judgment is?
The decision made regarding the course of action a nurse will take to solve a client problem.
201
Clinical reasoning requires the nurse to be able to do which of the following?
Separate relevant from irrelevant data.
202
A beginning student nurse is providing client-centered care for an adolescent who was admitted for tests to determine if he has type 1 diabetes mellitus. Which of the following statements by the student indicates a need for further teaching?
"I will keep my communication with the client to a minimum."
203
An advanced student nurse assigned to clinical in a rehabilitation setting is preparing to participate in a team meeting. Which of the following statements by the student indicates a need for further teaching?
“The provider will not be at the meeting because she is not a member of the interdisciplinary team.”
204
A student is developing a plan of care for a client who has been diagnosed with cancer of the pancreas. Which of the following would be an appropriate resource to use in the development of an evidence-based plan of care?
- CINAHL
- MedlinePlus
- OVID
205
Process of planning improvement strategies, implementation of those strategies, analyzing the impact of the strategies, and making changes to strategies as needed.
PDSA cycle
206
The procedure of reviewing the standards that are followed in the delivery of care.
Process audit
207
Evaluation or measurements of the impact environmental resources and influences have on the provision of care.
Structure audit
208
Analysis of the actual result, or impact, of delivered care.
Outcome audit
209
Performed in response to a sentinel event by collecting and analyzing related data, and outlining corrective actions.
Root cause analysis
210
Which of the following are client attributes that impact safety? (Select all that apply.)
- lifestyle choices
- communication patterns
- cognitive awareness
211
Web-based information should be evaluated for which of the following? (Select all that apply.)
- accuracy
- sponsorships
- currency
212
The use of intellectual skills to impart new knowledge to an individual.
Cognitive
213
Characterized by a shift or change in attitudes or beliefs.
Affective
214
Integrates mental and physical activities in the acquisition of new skills.
Psychomotor
215
A nurse is making rounds on clients, who were assigned to a team of nurses, to determine if charting and client care was completed. This nurse is demonstrating which leadership role of the nurse?
Coordinator
216
Giving priority in the following order to a client experiencing an alteration in airway status, breathing pattern, or circulatory status.
ABC
217
Giving priority to nursing actions that focus on collection of assessment data.
Nursing process
218
Giving priority to clients in a resource-limited setting who are severely injured but could live if supportive care is provided
Survival potential
219
Giving priority to interventions that prevent a client from becoming injured.
Safety and risk reduction
220
Giving priority to interventions that protect a client by using the most effective and least confining measures possible.
Least restrictive
Introduction to Nursing
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