Foundation of Nursing (Test 1)
What is the basis for nurses for critical thinking?
"Big picture" care as a result of nurse critical thinking results in safer, more thorough patient-centered care with more positive patient outcomes.
What is involved in the planning stage of the nursing process?
(After identifying a patient's nursing diagnosis and collaborative problems) the nurse prioritizes the diagnoses, sets patient-centered goals and expected outcomes, and chooses nursing interventions appropriate for each diagnosis.
Describe the chain of infection.
(Cyclical...) Infectious agent -> Reervoir -> Portal of exit -> Mode of transmission -> Portal of entry -> Host -> back to Infectious agent
What are the two steps of assessment?
1. Collect information from a primary source & secondary source 2. Interpret and validate data to ensure a complete database
What is a collaborative problem?
A collaborative problem is an actual or potential physiological complication that nurses monitor to detect the onset of changes in a patient's health status.
What is a goal?
A goal is a broad statement that describes a desired change in a patient's condition, perceptions, or behavior
What is a medical diagnosis?
A medical diagnosis is the identification of a disease based on a specific evaluation of physical signs and symptoms, a patient's medical history, and the results of diagnostic tests and procedures.
What is a nursing diagnosis?
A nursing diagnosis is a clinical judgement concerning human response to health conditions/life processes, or vulnerability for that response by an individual, family, or community that a nurse is licensed and competent to treat.
What is nursing theory?
A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care.
How can you ensure your goal is patient-centered?
A patient-centered goal reflects a patient's highest possible level of wellness and independence in function, it is realistic and based on a patient needs, abilities, and resources (reflects patient's specific behavior, not your own goals or interventions)
What order is the nursing process to be done?
A ssessment N ursing D iagnosis P lanning I intervention E valuation
What are clinical practice guidelines/protocols? Why are they used?
A systematically developed set of statements that helps nurses, physicians, and other health care providers make decisions about appropriate health care for specific clinical situations They improve quality of care and are evidence-based
What is a theory?
A theory helps explain an event by defining ideas or concepts, explaining relationships among the concepts, and predicting outcomes.
What is caring?
A universal phenomenon influencing the ways in which people think, feel, and behave in relation to one another. Caring means that people, events, projects, and things all matter to people, it is a word for being connected.
What are nursing standards of practice?
ANA Standards of Practice: 1) Assessment 2)Diagnosis 3) Outcome Identifications 4) Planning 5) Implementation 5a) Coordination of Care - the RN coordinates care delivery 5b) Health Teaching and Health Promotion - the RN uses strategies to promote health and a safe environment 5c) Consultaion- the graduate-level prepared specialty nurse or advanced practice nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change 5d) Prescriptive Authority & Treatment- the advanced practice RN uses prescriptive authority, procedures, referrals, treatment, and therapies in accordance with state and federal laws and regulations
Define mobility.
Ability to move freely ( as in to perform activities of daily living (ADLs) and recreational activities)
What are the benefits of obtaining advance certifications?
An advanced practice registered nurse (APRN) is the most independently functioning nurse, they are able to function as clinicians, educators, case managers, consultants, and researchers within their field of practice to plan or improve the quality of nursing care for patients and families.
The NCSBN (who administers the NCLEX) uses what term instead of diagnosis to describe the second step of the nursing process?
Analysis
What is necessary when preparing for implementation?
Anticipate & prevent complications, identify areas of assistance.
What is a nursing intervention?
Any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes (ideally, evidence based).
What are the steps needed when developing a nursing diagnosis? (assessment, data clustering, identifying patient health problems, formulation diagnosis, etiology or cause)
Assessment validate data, interpret and analyze data, data clustering (group signs and symptoms, classify and organize), look for defining characteristics and related factors Identify patient needs, formulate nursing diagnoses and collaborative problems, Etiology (problem related to...etiology)
What are evaluative measure? What are they similar to?
Assessment skills and techniques (same as assessment measures, but you perform them at the point of care that you make decisions about a patient's status and progression).
Define bed-rest.
Bed rest: restricts patient to bed for therapeutic reasons (including...) a. Reducing physical activity and the oxygen needs of the body b. Reducing pain, including postoperative pain or after acute injury, to the lower back c. Allowing ill or debilitated clients to rest d. Allowing exhausted clients the opportunity for uninterrupted rest
What are Benner's stages of nursing proficiency? What would make someone an expert? A novice?
Benner's stages of nursing proficiency are; Novice- beginning nursing student, uses linear steps to complete tasks Advanced Beginner- a nurse who has some level of experience Competent- nurse who has been in same position 2 to 3 years Proficient- plus 2 to 3 years in same position, focuses on managing care/bigger picture as opposed to just completing tasks Expert- nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem
What are the components of a health history exam?
Biographical information Chief concern or reason for seeking health care Patient Expectations Present illness or health concerns Health history Family history Psychosocial history Spiritual health Review of systems
What is clinical reasoning? (page. 220)
Choosing the options for best patient outcomes on the basis of a patient's condition and the priority of the problem
What events marked changes in nursing?
Civil war
What components are important to consider when making a clinical decision?
Clinical condition of patient, Maslow's hierarchy of needs, the risks involved in treatment delays, environmental factors (staff resources available), and patients' expectations of care, also important to consider delegation of tasks as necessary
How does critical thinking apply to implementation and standardization of care?
Clinical judgment includes making appropriate interpretations or conclusions about the interventions used to address a patient's human response to health conditions or life processes. Critical thinking allows you to consider the complexity of interventions, changing priorities, alternative approaches, and the amount of time available to act.
What skills are necessary for implementation?
Cognitive skills - critical thinking & good judgment Interpersonal skills - trusting relationship and level of caring expressed Psychomotor skills - integration of cognitive and motor activities (like giving an IM injection safely and correctly)
What are the attitudes of critical thinking?
Confidence, thinking independently, fairness, responsibility and authority, risk taking, discipline, perseverance, creativity, curiosity, integrity, and humility
Describe the modes of transmission.
Contact: Direct Indirect Droplet Airborne Vehicles Vector (ex. mosquito)
What is critical thinking?
Critical thinking involves open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant
What are two categories of specific critical thinking?
Diagnostic reasoning - the analytical process for determining a patient's health problems Inference - the process of drawing conclusions from related pieces of evidence and previous experience with the evidence
When would a consult be used? What are the 5 steps for making a consult?
During a consultation, you seek the expertise of a specialist such as your nursing instructor, a health care provider, or a clinical nurse educator to identify ways to handle problems in a patient management or in the planning and implementation of therapies 1) assess the situation and identify the general problem area 2) direct the consultation to the right professional 3) provide consultant with relevant information about the problem area and seek a solution 4) do not prejudice or influence consultants 5) be available to discuss a consultant's findings and recommendations
What are the benefits of joining professional organizations?
Employment opportunities, deals and research, education, personal and professional development, certification, career assistance, broadens perspective, conventions, and networking
What is the purpose of evaluation?
Evaluation is crucial to determine whether, after application of 4 steps, a patient's condition or well-being improves
What should an intervention be based-on?
Evidence-based (the most current, up to date, and effective approaches) based on prior nursing diagnosis.
What is the role of evidence-based knowledge in critical thinking?
Evidence-based knowledge is based on research or clinical expertise, utilizing this information allows you to make informed decisions and prepares you to better anticipate the needs of your patients, identify comfort problems quickly, and offer appropriate care.
What indicates and nurse's ability to perform evaluation?
Examine the results according to clinical data collected Compare achieved effect with goals and expected outcomes Recognize errors Understand a patient situation, participate in self-reflection, and correct errors
Review the history of nursing.
Florence Nightingale - established the first nursing philosophy based on health maintenance and restoration, developed first organized training program for nurses "Nightingale Training School for Nurses," SHE WAS THE FIRST EPIDEMIOLOGIST (her statistical analyses connected poor sanitation with cholera and dysentery)
What theorists are related to caring?
Florence Nightingale began implementing caring studies, but... Benner - interpreted nurses' stories and offered a rich, holistic understanding of nursing practice and caring Leininger's Transcultural Caring - describes the concept of care as the essence and central, unifying, and dominant domain that distinguishes nursing from other health disciplines Watson's Transpersonal Caring - caring is a central focus of nursing and it is internal to maintain the ethical and philosophical roots of the profession Swanson's Theory of Caring - studied patients and professional caregivers in an effort to develop a theory of caring for nursing practice (involves 5 caring processes...Knowing, Being with, Doing for, Enabling, Maintaining belief)
Who represents key figures in the history of nursing?
Florence Nightingale- first epidemiologist (connected dirt/uncleanliness to disease) Clara Barton - founded Red Cross in civil war era Mary Mahoney - first African American professionally trained nurse (concerned with effect culture had on healthcare) Mary Nutting - first nursing professor (/nursing started to move towards university education)
Of all of the "care" which is the priority? (technology, family, relationship, etc.)
Focus on holistic and humanistic approaches, patient centered and human centered approaches take priority
How should assessment move?
General to specific
Differentiate between a goal and an expected outcome.
Goal is broad, expected outcome is specific and includes a time and is used to reach a goal.
In what ways can caring being provided to a family?
Help the family to be active participants, educate family and encourage
Distinguish between high, intermediate and low priority nursing diagnosis.
High - nursing diagnoses that, if intreated, result in harm to patient or others Intermediate - involve non emergent, non-life threatening needs of patients Low - not always directly related to a specific illness or prognosis but affect a patient's future well-being
What is the relationship between evaluation and trends?
In many clinical situations it is important to collect evaluative measures over a period of time...trends may be important in assessing if a patient outcome was reached or not.
What three types of interventions are there?
Independent nursing interventions- actions that a nurse initiates without the supervision or direction from others Healthcare provider initiated (dependent nursing interventions) - actions that require an order from a health care provider Collaborative interventions - therapies that require the combined knowledge, skill, and expertise of multiple healthcare providers
What is a cue?
Information you obtain through use of the senses
How should the nursing process be initially used? How will it change as you gain clinical experience?
Initially, you will learn how to apply the process step by step however as you gain more clinical experience and care for more patients you will learn to move back and forth through the steps of the process (critically making judgements about your patient's clinical situations and individualizing your approaches to care
What are the standards of critical thinking?
Intellectual standards - principle for rational thought Professional Standards- refer to ethical criteria for nursing judgements, evidence-based criteria used for evaluation, using critical thinking for the good of others
What is the significance of hand-off reporting?
It is a critical time to ensure continuity of care for a patient and helps in preventing errors or delays in providing nursing interventions.
What role does critical thinking play in assessment?
It's SO IMPORTANT. While gathering data about a patient, you synthesize relevant knowledge, recall prior clinical experiences, apply critical thinking standards and attitudes, and use professional standards of practice to direct your assessment in a meaningful and purposeful way.
What does it mean to know the patient? How is this developed?
Knowing the patient comprises both a nurse's understanding of a specific patient and his or her subsequent selection of interventions
What are the three levels of critical thinking?
Level 1 - Basic Level 2 - Complex Level 3 - Commitment
What constitutes direct care? (examples)
Medication administration, vitals, etc
What can change in mobility affect? (consider risks, diagnosis, & interventions)
Metabolic - immobility decreases metabolic rate (easier weight gain, increased risk for drug toxicity) Respiratory - lack of movement places patients at risk for respiratory complications (ex. pneumonia) Cardio - thrombus formation, orthostatic hypertension, and increased cardiac workload (blood clot) Musculoskeletal - immobility causes permanent or temporary impairment or permanent disability (muscle degeneration) Urinary - lack of gravity makes it harder for urine to flow from ureters to bladder (increased risk for UTI's) Integumentary - risk for pressure ulcers (also because of decreased metabolic rate) (pressure ulcers!!) Psychosocial - emotional and behavioral responses, sensory alterations, and changes in coping
Differentiate between the major nursing theorists.
Nightingales Environmental theory - linked patient's health status to environmental factors and initiated and improved hygiene and sanitation conditions Peplau's Interpersonal Theory - developing the nurse-patient relationship ("mother of psychiatric nursing") Orem's Self-Care Deficit Theory - when applying theory, a nurse continually assesses a patient's ability to perform self-care and intervenes as needed to ensure the patient meets physical, psychological, sociological, and developmental needs Leininger's Culture Care Theory - goal of nursing care is to provide patient culturally specific care
What is the purpose of developing a formal nursing diagnosis?
Nursing diagnosis is a universal means for communication among professional nurses and across other leash care disciplines
What is nursing? Why is it an art? Why is it a science? How is it a profession?
Nursing is an art because it requires delivering care artfully with compassion, respect, and caring. It is a science because nursing practice is based on a body of knowledge that is continually changing with new discoveries and innovations. A variety of career opportunities are available in nursing and it is a field you could continually study and grow into for the remainder of your life. Because of this, nursing is considered a profession.
What are the essential elements of professional nursing?
Nursing is 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 advocate in the care of individuals, families, communities, and populations.
Why do we need nursing theories?
Nursing theories offer a perspective for assessing your patient's situation. They also help you organize, analyze, and interpret data.
What does PQRST mean and what is it used for?
PQRST is a pain assessment method and it stands for: Provocation/Palliation Quality/Quantity Region/Radiation Severity Scale Timing
Name six sources for collecting patient data
Patient Family & Significant others Health Care Team Medical Records Other Records & Scientific Literature Nurse's Experience
What is patient centered care? What is relationship centered care?
Patient centered care is care the focuses on the needs of the individual, relationship centered care is the prioritizing of the patient-nurse relationship while caring for a patient
Who generally offers the best source of information?
Patient is usually best source of information
What are the four components of the nursing paradigm?
Person, Health, Environment/Situation, Nursing (The nursing paradigm allows nurses to explain what nursing IS, what nursing DOES, and WHY nurses do what they do. The four components of the nursing metaparadigm are: Person - is the recipient of care including individual patients, groups, cultures, families, and communities: each person's needs are complex and so patient-centered care is important Health - (has different meanings for each patient) it is a state of being that people define in relation to their own values, personality, and lifestyle...it is dynamic and constantly changing Environment/Situation- includes all possible conditions affecting patients and the settings where they go for their healthcare Nursing - nursing is, "...protections, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering though the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations." (ANA, 2014))
What is presence and how is it provided?
Presence is "being there" and "being with." Providing presence is a person-to-person encounter conveying a closeness and a sense of caring.
What are the three types of nursing diagnosis? Differentiate between them.
Problem-focused - describes a clinical judgement concerning an undesirable human response to a health condition/life process that exists in an individual, family, or community Risk - a clinical judgement concerning the vulnerability of an individual, family, group, or community for developing an undesirable human response to health conditions/life processes Health Promotion - a clinical judgement concerning a patient's motivation and desire to increase well-being and actualize human health potential
What is QSEN?
Quality and Safety Education for Nurses, competencies include; patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (use of knowledge and technology to communicate, manage knowledge, mitigate error, and support decision making)
How does reflection play a role in critical thinking?
Reflection is the turning over of a subject in the mind and thinking about it seriously. This situation specific recall may allow you to better care for your patients in the future. Allows your critical thinking to move to the next level by drawing from past experience
What is a SMART goal?
SMART goals are Specific, Measurable, Action-Oriented, Realistic and Timely. 'Specific' refers to who, what, when, where, and why.
What are the three categories of general critical thinking?
Scientific Method (Identify problem, collect data, formulate a question or hypothesis, test the question or hypothesis, evaluate the results of the test or study AKA IDQTE) Problem solving - involves evaluating a situation over time, identifying possible solutions, and trying a solution over time to make sure it is effective Decision making - focuses on problem resolution
What is a scope of nursing practice?
Scope of practice refers to the professional activities defined under state law. The scope of practice for nurses is determined by each state's nurse practice act.
What is Maslow's hierarchy of needs? Given a situation, determine which need is priority.
Self-Actualization Esteem Love/Belonging Safety Physiological (SELSP) Always address bottom of pyramid first (ie, before a patient's safety can be attended to, their physiological needs must FIRST be met).
What nursing diagnosis have the highest priority?
Set priorities using notions or urgency and important to establish a preferential order for nursing interventions. Prioritize nursing diagnoses that, if untreated, result in harm to patient or others (such as ABC's)
How does stress affect critical thinking? What are indicators of stress?
Stress impairs judgement in a 12 hour shift because of the way stress affects attention, can lead to poor work productivity, impaired decision making and communication, and reduced ability to cope with clinical situations. Some indicators of stress include tense muscles, reactivity when others communicate with you, trouble concentrating, or you may feel very tired.
Why are students required to write extensive care plans?
Student care plans help you learn problem-solving techniques, the nursing process, skills of written communication, and organizational skills for nursing care, most importantly they help you apply scientific knowledge gained from the scientific literature and the classroom to a practice situation
What two types of data are involved in assessment? Differentiate between the two.
Subjective - patient's verbal descriptions of their health problems vs. Objective - observations or measurements of a patient's health status (measurable)
What role did the Civil War play on nursing?
The civil war stimulated the growth of nursing in the US, Clara Barton founded the American Red Cross (& tended to soldiers on the battlefields cleansing wounds, meeting their basic needs, and comforting them in death)
What are the levels of theory?
The components of a theory are; Phenomenon - the term, description, or label given oto describe an idea or responses about an event, a situation, a process, a group of evens, or a group of situations (may be temporary or permanent) Concepts - the words or phrases that identify, define, and establish structure and boundaries for ideas generated about a particular phenomenon. Think ideas and mental images (ranging from abstract such as emotions to concrete such as physical objects) Definitions - used to communicate the general meaning of the concepts of a theory Theoretical/Conceptual Definition - dictionary definition (ex./ pain is defined as physical discomfort) Operational Definition - states how concepts are measured (ex./ pt. reports pain as 3 on scale of 1 to 10) Assumptions- truths based on values and beliefs, "taken for granted" statements that explain the nature of the concepts, definitions, purpose, relationships and structure of a theory VS Grand theories - most abstract Middle-range theories - less abstract Practice theories - situation-specific theories that bring theory to the bedside Descriptive theory - describe phenomena and identify circumstances Prescriptive theory - address nursing interventions for a phenomenon, guide practice change, & predict the consequences
What is atrophy?
The degeneration of cells
Define assessment.
The deliberate and systematic collection of information about a patient to determine the patient's current and past health and functional status and his or her present and past coping patterns
Define immobility.
The inability to move freely.
What is an expected outcome?
The measurable change that must be achieved to reach a goal (Measurable, Objective, Realistic, Time)
What is the nurse practice act and what is the purpose of it?
The practice of nursing is a right granted by a state to protect those who need nursing care. Safe, competentnursing practice is grounded in the law as written in the state nurse practice act (NPA) and its rules. Nurse Practice Act and Rules.
What is touch? What is the difference between caring touch and task-oriented touch? What is noncontact touch?
The use of touch is one comforting approach that reaches out to patients to communicate concern and support. Task oriented touch - when performing a task, caring touch when nonverbal communication (like holding patient's hand, etc.) Protective touch - to prevent injury Noncontact touch - is a pseudoscientific energy therapy which practitioners claim promotes healing and reduces pain and anxiety
How can you implement family care?
Think of a family as a set of relationships that a patient identifies as family or as a network of individuals who influence one another's lives, whether or not there are actual biological or legal ties. Teach family how to keep relative physically comfortable etc.
What are the five preparatory activities for the implementation process?
Time management Equipment Personnel Environment Patient
Why are their standardized interventions?
To provide evidence based treatment guidelines
What are common postural abnormalities?
Torticollis - inclining head to affected side, sternocleidomastoid muscle contracted Lordosis - exaggeration of anterior convex curve of lumbar spine Kyphosis - increased convexity in curvature of thoracic spine Scoliosis - lateral S or C shaped spinal column (unequal heights of hips and shoulders) Congenital Hip Dysplasia - hip instability with limited abduction of hips Knock-knee - legs curved inward so knees come together as person walks Bowlegs - bent outward at knee Clubfoot - medial deviation and plantar flexion of foot (usually) also lateral deviation and dorsi flexion Footdrop - inability to dorsiflex and invert foot because of nerve damage Pigeon toes - internal rotation of foot (common in infants)
What are standing orders? Who writes them? Who initiates them?
What? Standing orders are preprinted documents containing orders for routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical outcomes Who writes them? Licensed prescribing health care providers Who initiates them? Nurses
What is interpretation? What is data validation? Differentiate between the two.
When interpreting assessment information, you determine the presence of abnormal findings, recognize that further observations are needed to clarify information, and begin to identify a patient's health problems vs. Data validation must be done before you complete data interpretation, validate the information you have collected to avoid making incorrect inferences
How is evaluation done?
You conduct evaluative measures to determine if your patients met expected outcomes (not if during interventions were completed).
What is an inference?
Your judgement or interpretation from these cues
What is direct care vs. indirect care?
direct care - treatments performed through interactions with patients indirect care - treatments performed away from the patient but on behalf of the patient/groups of patients (eg documentation, interdisciplinary collaboration)
How/Why is a care plan discontinued or modified?
discontinued when...after you determine your patient has met or exceeded outcomes and goals (and evaluation is confirmed with patient if possible) modified when...when patients do not meet goals or outcomes (you then identify the factors that interfere with their achievement)
What constitutes indirect care? (examples)
documentation, interdisciplinary collaboration
