1. Foundations of Professional Nursing

What degrees are considered professional registered nurse education?

-2 years associate's degree -4 years baccalaureate degree

Healthy People 2020 Goals

-Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death -Achieve health equity, eliminate disparities, and improve the health of all groups -Create social and physical environments that promote good health for all -Promote quality of life, healthy development, and healthy behaviors across all life stages.

Successful practice in the community involved what?

-Building relationships with the community -Being responsive to changes within the community

What five characteristics prove that nursing is a profession?

-Educated and well-trained -Body of knowledge allows you to acquire skills -You'll provide service to others -Have autonomy in decision making and practice -A code of ethics will guide your practice

What do risk factors include? (4)

-Genetic and physiological factors -Age -Environment -Lifestyle

Approaches to Health Care Among the Elderly

-Health Promotion -Education -Advocacy -Program development -Illness Prevention

What are some problems that health care providers face in communities?

-Increases in homelessness -Increases in immigrants -Increases in STIs -Underimmunized infants and children -Chronic and/or life-threatening diseases such as HIV and emerging infections]

What provisions do The Patient Protection and Affordable Care Act include?

-Insurance industry reforms -Increased funding for community health centers -Increased primary care services -Improved coverage for children

What is considered a graduate education?

-Master's degree, advanced practice RN -Doctoral degrees

8 Issues in Health Care Delivery

-Nursing shortage -Competency (IOM) -Evidence Based Practice -Quality and safety in health care/Patient-centered care -Health care organizations are being evaluated on the basis of outcomes (as prevention of complications, pts' functional outcomes, and pt satisfaction) -Magnet Recognition Program -Nursing informatics and technological advancements -Globalization of health care

Institute of Medicine (IOM) How do nurses need to be transformed?

-Practicing to the full extent of their education and training -Achieving higher levels of education and training through an improved education system that provides seamless progression -Becoming full partners, with physicians and other providers, in redesigning the health care system -Improving data collection and the information infrastructure for effective workforce planning and policy making

Health promotion lowers the overall cost of health care by

-Reducing incidence of disease -Minimizing complications -Reducing the need for more expensive resources -Occurs in home, work, and community settings

The delivery of health care causes what four factors?

-Rising health care costs -Evidence-based practice -Nursing and biomedical research -Nursing shortage

What six types of changes in society lead to changes in nursing?

1) Health care reform 2) Demographic changes 3) Women's Health Care Issues 4) Medically underserved 5) Threat of bioterrorism 6) Rising health care costs

IOM Competencies (5) p.23

1) Provide Patient Centered Care 2) Work in Interdisciplinary Teams 3) Use Evidence-Based Practice 4) Apply Quality Improvement 5) Use Informatics

What are a nurse's four tasks?

1) Respond to needs of patients 2) Actively participate in policy 3) Respond and adapt to challenges 4) Make clinical judgments and decisions about patients' health care needs based on knowledge, experience, and standards of care

ANA Standards of Nursing Practice

1. Assessment: Collect data pertinent to the patient's health 2. Diagnosis: Analyzes the data to determine the diagnoses 3. Outcome ID: Identifies expected outcome for an individualized plan 4. Planning: Plan strategies to attain expected outcome 5. Implementation: Implements plan through (a) Coordination of care (b) Health teaching and health promotion (c) consultation (d) prescriptive authority and treatment 6. Evaluation: Evaluates progress toward attainment of outcomes

What are the competencies that QSEN (Quality and Safety Education for Nurses) addresses?

1. Patient-centered care 2. Teamwork and Collaboration 3. Evidence-Based Practice 4. Quality Improvement 5. Safety 6. Informatics

Discharge planning

A centralized, coordinated, multidisciplinary process that ensures that the patient has a plan for continuing care after leaving a health care agency

What are diagnosis-related groups (DRGs)?

A fixed reimbursement amount with adjustments; hospital services bundled

How is a nurse a communicator?

A nurse communicates with his/her patients and members of their support system.

How is a nurse a manager?

A nurse manages the care of the patient by working with other to help your patients meet their established outcomes and will evaluate the manner in which care is administered. As a manager of care, you will evaluate staff nurses to determine whether they meet professional and health care facility standards.

Competent Nurse

A nurse who has been in the same clinical position for 2 to 3 years.

Advanced Beginner Nurse

A nurse who has had some level of experience with the situation.

Expert Nurse

A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem.

Proficient Nurse

A nurse with more than 2 to 3 years of experience in the same clinical position.

Definition of Health

A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity

What three areas will you incorporate as you begin your practice?

ANA standards, evidence-based practice, and critical thinking skills

What are some of the major goals that The Patient Protection and Affordable Care Act focus on?

Access to health care for all Reducing costs Improving quality

Demographic changes (rural to urban)

Access to health care in rural areas have become a serious problem, due to a severe shortage of primary care providers.

What characteristics are needed to be considered a profession?

Acting professionally by administering quality patient-centered care in a safe, conscientious, and knowledgable manner.

When rendering care, you will be guided by a code of ethics developed by who?

American Nurses Association

Nursing is both _____ and _______?

An art and science

To meet the needs of an increasingly complex client population, nurses must demonstrate the ability to be what?

Autonomous and accountable

Novice Nurse

Beginning nursing student or any nurse entering a situation in which there is no previous level of experience

How can nurses plan for better patient care?

By learning early what a patient expects with regard to information, comfort, and availability of family and friends

What are the two duties for community health nurses?

Care for the community as a whole and assess the individual or family within the context of the community

What are the five professional roles of a nurse?

Caregiver; Advocate; Educator; Communicator; Manager

Who are the most vulnerable groups of people most threatened by urbanization?

Children, women, and older adults

Art is based on the practice of what?

Compassion, respect, and dignity rendered to the client and family members alike.

Continuing and in-service education

Continuing: involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions In-service education: instruction or training provided by a health care agency or institution

The health care needs of society are influenced by what three variables?

Economic, social, and cultural values of a specific era

Nurses have been able to carry on the traditions of which public figure?

Florence Nightingale

Primary care

Focuses on improved health outcomes for an entire population (ex: health education, nutrition)

Hospice

Focuses on palliative (not curative) care: comfort, independence, and dignity; Hospice care can be provided at home, within a homelike setting, or within the hospital setting.

Preventive care

Focuses on reducing and controlling risk factors for disease through activities such as occupational health programs

Teamwork and Collaboration

Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care

Threat of Bioterrorism

Health care agencies are training future and practicing nurses to deal with nuclear, chemical, and biological events.

Health care providers define the quality of their services by measuring what?

Health care outcomes

What was the focus of Florence Nightingale's career?

Health maintenance and restoration

What three factors do nurses incorporate rather than simply just treating a disease?

Health promotion, wellness, and illness prevention

Major Problems of Older Adults

Hypertension Cancer Arthritis Sensory impairment Confusional states/Alzheimer's disease Dental problems Drug use and substance abuse

Evidence-Based Practice

Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care

Tertiary care

Intensive care unit, specialized technical hospital (ex: orthopedic, children's hospital)

Rising health care costs

It doesn't benefit everyone. Also, the perception of quality of life differs for every individual.

Science is based on a body of what?

Knowledge that is constantly changing and evolving

What three factors are the American Nurses Association (ANA) concerned with?

Legal aspects of nursing practice, public recognition of the significance of nursing practice to health care, and implications for nursing practice generated by trends in health care

What does the Nurse Practice Act establish?

Legal regulations for practice in a specified area (narrows down to what nurses can and can not do)

What was established to recognize health care organizations that achieve excellence in nursing practice?

Magnet Recognition Program

Health promotion

Maintain or enhance health

What provides administrative control over primary care services for a defined patient population?

Managed care

What event in history stimulated the development of nursing?

Men were nurses, but since they had to go to war, women took over the nursing field to care for the injured.

Safety

Minimize risk of harm to patients and providers through both system effectiveness and individual performance.

All students who graduate from schools of nursing are eligible to take what test?

NCLEX-RN (2 year or 4 year college)

What program allows schools to join voluntarily to publish interpretive guidelines that identify core competencies for the professional nurse?

National League for Nursing Accreditation Council (NLNAC)

How is a nurse a caregiver?

Nurses help their patients regain health and find their maximum level of independent function through the healing process. Healing involves the body, mind, and spirit.

How is a nurse an advocate?

Nurses protect the human and legal rights of their patients and help patients assert those rights when needed. (looking for the best interest of the patient)

International Council of Nurses (ICN) definition

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and in all settings. Nursing includes promotion of health; prevention of illness; and the care of ill, disabled, and dying people.

What are the benefits of researches?

Nursing knowledge advances and nurses become better able to provide up-to date, higher quality nursing care.

Adult Day Care Centers

Offers services to patients in need of daily physical rehabilitation, counseling for emotional, drug, alcohol addiction

What does the Healthy People Initiative establish?

Ongoing health care goals

The twenty-first century nurse deals with what four factors?

Pain management, nutrition management, care of the elder population, and care of the infant and the underserved child

Who has done extensive work on the development of proficiency of nurses?

Patricia Benner

Capitation

Payment mechanism by which providers receive a fixed amount per patient or enrollee of a health care plan

Continuing care

People who are disabled, functionally dependent, or suffering a terminal disease

Secondary acute care

Pertain to specific illnesses or current illnesses (ex: in-patient, psychiatric hospital, ACUTE patients)

Because of rising health care costs, what is your responsibility as a nurse?

Practice safe nursing care while staying fiscally sound.

What are the two outgrowths that attempt to control the cost of health care spending?

Professional standards review organizations (PSROs) and utilization review committees (URs)

What eliminates cost-based reimbursement?

Prospective payment system

Health care reform

Protecting the rights of those who are underinsured or uninsured and giving them the chance to earn healthcare benefits.

Patient-Centered Care

Recognize the patient or designee as the source of control and a full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs

Assisted living

Resident autonomy, laundry, meals, personal care, some help with meds; residents live in their own units; little government regulation

What group is utilized in long-term care settings?

Resource utilization group (RUGs)

Restorative care

Serves patients recovering from an acute or chronic illness/disability; Helps individuals regain MAXIMUM LEVEL OF FUNCTIONING and enhance quality of life.

Respite care

Short-term relief for the caregiver

Public health problems are influenced by what?

Social lifestyles Political policy Economic initiatives

In nursing, care is provided according to what?

Standards of practice and a code of ethics

What is the goal for interventions?

Strengthen self-care capacities

Wellness

TEACHES patients how to care for themselves

Who established the Magnet Recognition Program?

The American Nurses Credentialing Center (ANCC)

Which group represents the 20% of all people in the United States and consume 80% of health care spending?

The acutely and chronically ill

Minimal practice requirements are set based on what?

The certification the nurse is seeking for

What is globalization?

The increasing connectedness of the world's economy, culture, and technology

The ANA definition of nursing

The protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations.

What does the PSRO review?

The quality, quantity, and cost of hospital care provided through Medicare and Medicaid

What does the Nurse Practice Act regulate?

The scope of nursing practice and protect public health, safety, and welfare. They also specify the training needed for nurse practitioners and other advanced practice professionals.

Medically Underserved

These conditions include those who have socioeconomic problems, limited transportation access, language barriers, or mentally ill patients.

Nursing definitions reflect what and bring about what?

They reflect changes in the practice of nursing and help bring about changes by identifying the domain of nursing practice and guiding research, practice, and education.

Because of nursing shortages, a big part of your education will be devoted to developing what skills?

Time management skills

What is the goal for the scope and standards of practice?

To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice.

Who designed the Healthy People Initiative?

U.S. Dept of Health and Human Services Public Health Service (USDHHS)

Quality Improvement

Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.

Informatics

Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.

Who reviews admissions, diagnostic testing, and treatments provided by physicians who cared for patients receiving Medicare?

Utilization review (UR) committee

Risk Factors

Variables that increase the vulnerability of an individual or a group to an illness or accident

When do nurses develop knowledge?

When nurses combine and identify relationships between different pieces of information

When do nurses gain or use information?

When they organize, structure, or interpret data

What do technological advancements influence?

Where and how nurses provide care to patients and can help nurses improve direct care processes, patient outcomes, and work environments

What type of changes affect health care (demographics)?

Women's demand for equality. Their demand to receive better care causes new advances to be made in obstetrics (giving birth), oncology (treatment of tumors), and research.

How is a nurse an educator?

Your teaching can be formal or informal and will involve the patient, family, significant other, or other support systems.

Illness prevention

protect against health threats and thus maintain an optimal level of health