INTRO FINAL

*1. assertive* - the healthiest form of communication - communicators who pronounce their basic rights without violating the rights of others - honest and direct - values and respects other individuals' views - seek a win-win solution - active listening and reflective feedback - set limits - although the most effective style, it is the style people use least *2. agressive* - communicators that make decisions for themselves and others with the intent of always coming out the winner - want their needs met exclusively and immediately - uses guilt, hurt, anger, and other manipulation tools - may include honesty in a hurtful way - feel superior to others and controlling - often leads to conflict *3. passive* communicators who are the polar opposite of aggressive communicators - allow others to make decisions for them in hope of avoiding confrontation or difficult situations - typically inhibited, indirect, and self-denying - takes the safe route - win in situations by chance - shares the opinion of the more aggressive person - are dishonest; don't state their true feelings or needs *4. passive-agressive* - communicators who combine the worst of both styles - avoid direct confrontation while manipulating others in order to achieve their personal goals - appear to be honest but "come in the back door" - undermines other individuals through gossip, pouting, playing the victim, and other manipulative behaviors - win in situations by making other individuals look bad passive-agressive what are

communication styles

- be sensitive and show respect for the differences in beliefs and values of others - inquire, learn about, and integrate beliefs and values of others in professional encounters - try to change negative and prejudicial behaviors in themselves and others nurses must be culturally competent because: - the nurse's culture is often different from the client's - care that is not culturally competent may be more costly - care that is not culturally competent may be ineffective - racial and minority groups experience profound disparities in health care

cultural competence

nurses must be knowledgable of the specific cultural practices in the region- forms of communication do not carry the same meaning - diverse practices of consuming food, use of blood

culture diversity and communication

the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome *delegatee responsibilities* responsibilities - accept activities based on own competence level - maintain competence for delegated responsibility - maintain accountability for delegated activity *licensed nurse responsibilities* - determine patient needs and when to delegate - ensure availability to delegatee - evaluate outcomes of and maintain accountability for delegated responsibility *the RN is accountable for:* - the act of delegation - supervising the performance - assessment and follow-up evaluation - any intervention or corrective actions - completing the task - communicating the appropriate information to the delegator *the 5 rights of delegation* 1. task 2. circumstances 3. person 4. direction and communication 5. supervision and evaluation *essential requirements for safe delegation* 1. know the patient 2. know the staff member 3. know the tasks 4. explain the task and expectation 5. expect action 6. assess and supervise 7. evaluate and follow up *the decision to delegate or not to delegate depends on 6 factors:* 1. nursing practice acts and other state laws 2. patient needs 3. job descriptions and competencies of staff members 4. policies and procedures of the health care organizations 5. clinical situation 6. professional standards of nursing practice

delegation

professional nursing roles

- care provider - educator and counselor - client advocate - change agent - leader and manager - researcher - coordinator of the interprofessional health care team

How long does the average meditation session need to last in order to be effective?

20 minutes

*1. environmental control* - the ability of members of a particular culture to control nature or environmental factors *2. biologic variations* such as body build and structure, genetic variations, skin characteristics, susceptibility to disease, and nutritional variations *3. social organization* - refers to the family unit and the religious or ethnic groups which families identify *4. communication* - differences include language, verbal and nonverbal behaviors, and silence *5. space* - refers to people's attitudes and comfort level regarding the personal space around them *6. time* - the view of time in the present, past, or future

6 cultural phenomena that vary among cultural groups and affect health care

a defined set of EHR capabilities and standards that EHR systems must meet to ensure that their full capacity is realized and for the users to quality for financial incentives from Medicare - a complex set of capabilities and standards to be met *quality and safety priorities of EHR's:* 1. improve quality, safety, and efficiency 2. engage patients and their families in their health care 3. improve care coordination 4. improve population and public health 5. ensure adequate privacy and security protections for personal health information

EHR "meaningful use"

many important influences in her life directed her toward theory development: 1. a classic education 2. upper-class background, great wealth, and a prominent social life 3. religion and spirituality 4. era of reform throughout England *Nightingale's definitions of nursing* - nursing is an art-an art requiring an organized, practical, and scientific training - nursing is putting us in the best possible conditions for nature to preserve health-to prevent, restore, or cure disease or injury - nursing is, therefore, to help the patient live - investigated the effect of the environment on healing

Florence Nightingale: The First Nursing Theorist

A diabetic patient comes into the clinic asking her health care provider about drinking Ginseng Tea because she has read it has a lot of beneficial uses. What caution should the provider inform the patient about?

Ginseng can lower blood glucose levels, especially for diabetic patients. The health care provider should recommend the patient does not use Ginseng because of her diabetes and the risks it can bring.

Why do people prefer Naturopathic way of treatment?

It encourages a healthy lifestyle, and its guides them in managing health problems using natural approaches such as herbs and exercise

A 67 year old man with a pacemaker comes into the ED complaining of pain. The patient request that he use an alternate method to his pain instead of taking morphine. When ask what the patient suggested alternate method, he stated he would like to use magnet therapy. As the nurse, what is the appropriate response to the patient?

Magnet therapy creates an electrical impulse to help with pain, since you have a pace maker, the electrical impulses between both the magnet and your pacemaker will interrupt each others electrical impulses.

Are you required to pray with a patient of a different religious faith than yourself?

No, you still have civil rights as a nurse but if you don't mind and there is no objection then you are welcome to support the patient in their psychological healing, which can then sometimes lead to physical healing.

Patient comes into the ER with kidney stones. What could be the most probable cause for the patient developing these kidney stones?

Patient consumes over 2500mg of calcium per day

What is required for hypnotherapy to be successful?

Patient must be in a state of deep relaxation

1. patient-centered care - recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs 2. teamwork and collaboration - function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care 3. evidence-based practice - integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care 4. quality improvement - use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continually improve the quality and safety of health care systems 5. safety - minimizes risk of harm to patients and providers through system effectiveness and individual performance 6. informatics - use information and technology to communicate, manage knowledge, mitigate error, and support decision making

QSEN competencies

was one of the first accreditation agencies to embrace QI principles as an accreditation requirement in hospital-based settings TJC introduced a performance measurement and improvement initiative, as part of the accreditation process called *ORYX* *core measures* shows how often a hospital provides each recommended treatment for certain medical conditions - hospitals began collecting data on standardized "core" performance measures now commonly known as *National Hospital Quality Measures*

The Joint Commission

*evacuate (RUN)* - if there is an accessible escape path, attempt to evacuate the premises - have an escape route - leave belongings behind - do not attempt to move wounded people - call 911 when you are safe - disregard others who do not follow *hide out (HIDE)* - if evacuation is not possible, find a place to hide where the active shooter is less likely to find you - be out fo the active shooter's view - provide protection - do not trap yourself prevent shooter from entering: - block door with heavy objects - silence phone - leave line open and allow dispatcher to listen *take action against the active shooter (FIGHT)* - as a last resort, and only when your life is in imminent danger, attempt to disrupt and/or incapacitate the active shooter by: - acting aggressively as possible - throwing items and improvising weapons - yelling - committing to your actions

active shooter

the placing of needles at specific points on the body to restore the imbalance of energy

acupuncture

means "the science of life" and is a system of care that promotes spiritual, mental , and physical balance

ayurveda

- nurses must first attempt to understand not just what they are to do for their patients but who their patients are - must examine life and its origins, in addition to its worth, usefulness, and importance - must determine their own values and seek to understand the values of others - has an obligation to present themselves to the patient as competent

balancing science and morality

1. lack of general understanding 2. limited number of palliative care trained professionals 3. how is it paid for? 4. communication

barriers to palliative care

a technique in which the client is taught to alter specific bodily functions (heart rate, blood pressure, muscle tension)

biofeedback

*pandemic influenza* - new influenza virus emerges in the human population, causing illness and death as it spreads worldwide - tracking and predicting pandemic flu *ebola* - through direct contact with blood or body fluids of a person will with Ebola, objects contaminated with the virus, or infected animals

biologic causes of mass casulty

what term is used to describe the combination of massage with deep-tissue manipulation, movement awareness, and energy balance?

bodywork

professional nursing role: - basic to the nursing profession - assess client resources, strengths and weaknesses, coping behaviors, and the environment to optimize the problem-solving and self-care abilities of the client and family - plans therapeutic interventions in collaboration with the client, physician, and other health care providers - takes responsibility for coordination of care that involves other health care professionals or resources providing continuity and helping the client deal effectively with the health care system

care provider

*1. partial-task vs whole-task system* partial-task: type of health care in which different members of the health care team divide the patient care into parts and only requires partial knowledge whole-task: type of health care in which requires complete knowledge and encourages loyalty to the profession- more consistent with what is taught in school- nurse provides total patient care *2. evaluation methods* - inconsistency between the school and work environment - will develop your own system and quality check for performing nursing care - "were all the steps carried out in a logical, correct and efficient way?"

causes of shock

professional nursing role: - identify client, patient safety, and health care delivery problems - assess individual and organizational motivation and capacity for change - determine alternative and explore possible outcomes of the alternatives - assess cost-effective resources in infinite health-related situations

change agent

Which CAM therapy corrects misalignments that disrupt normal body functions and cause issue with nerves?

chiropractic

based on the belief that misalignments of the spine put pressure on the nerves, leading to pain and disruptions by manipulation and adjustment of the spine

chiropractic medicine

professional nursing role: - essential in various situations with a multitude of client populations - promoting what is best for the client, ensuring the client's needs are met, and protecting the client's rights

client advocate

the process whereby workers organize under the representation of a union in order to share a degree of power with management to determine selected aspects of the conditions of employment goals: establish reasonable working conditions and establish formal agreements between employees and management for wages and health and retirement benefits - a union organizing drive may be initiated when nurses contact a union because they feel a need for help in negotiating with their employer *a newly formed union will:* 1. have the power to make certain demands 2. provide some degree of political power 3. require nurses to pay dues to the union 4. give the union additional power by adding more members and more bargaining units 5. increase monetary support for the union through dues paid by nurses *authorization cards:* help the union organizer to decide whether there is enough interest in unionization - this designates the union to serve as his/her bargaining agent or legal representative - 30% signed cards means interest in representation by the union - if 50% + 1 of eligible nurses vote to accept the union, the nurses are now represented by the union and are now unionized *during the pre-election period, unions may not:* 1. inflame racial prejudices 2. lie about loss of jobs if the union loses the election 3. forge documents or signatures 4. meet or distribute literature in work areas during work times 5. hold meetings within 24 hours of an election *during the pre-election period, management may not:* 1. solicit spying 2. photograph employees engaged in union activities 3. visit employees in their homes 4. lie about what will happen if the union is the victor in an election 5. question employees about their preferences regarding union activity *election process:* 1. . the union or employer must petition the NLRB for an election 2. within 48 hours, the union must submit proof of its claim that 30% of eligible nurses are interested in forming a collective bargaining unit 3. for a 10-day period, literature will be distributed among both sides, however union and employer must cease activities within 24 hours within the election 4. secret ballot votings held by the NLRB - on the day of election, the NLRB, union representatives, and employer representatives meet to review the list of those eligible to vote: 1. the three parties count the ballots and in the event of a tie, the employer is declared the victor 2. dispute and objections can be made within 5 working days after the election and ballots recounted

collective bargaining

sender, receiver, and a message *intepretation:* receiver's understanding of the meaning of the communication *factors that influence interpretation:* 1. context and environment - refers to the entire situation relevant to the communication, such as the background, and the particular circumstances that lead to the discussion 2. precipitating event - refers specifically to the event or situation that prompted the communication - specific single event 3. preconceived ideas - refers to conceptions, opinions, or thoughts that the receiver has developed before the encounter 4. style of transmission - include aspects such as open or closed statements or questions, body language, method of organizing the message, degree of attention, vocabulary, and intonation 5. past experiences - refers to the variety of positive, neutral, and negative events that will influence communication to be positive, neutral and negative 6. personal perceptions - described as all that the person knows about a situation or circumstance based on what each of the senses discover and interpret

communication process

*practical or vocational nurse program:* pre-pares for LVN or LPN license institution: high school, hospitals, vocational-technical schools; some college length: 9 to 12 months purpose and scope: basic technical bedside care; hospitals, nursing homes, home care, offices in LPN positions *diploma program: prepares for RN license* institution: hospitals, some in conjunction with colleges length: 2 to 3 years purpose and scope: basic RN positions; hospitals and agency care *associate degree in nursing: prepares for RN license* institution: community and junior colleges length: 2 years; some are 1 year bridge programs for LPN/LVN graduates purpose and scope: basic technical care in RN positions, primarily in institutions *bachelor's degree in nursing (BSN): prepares for RN license* institution: colleges and universities length: 2 to 4 years (depends on type of option); some are 1- to 2-year mobility options for graduates of PN or ADN programs or accelerated options for second-degree students purpose and scope: basic professional practice as RN; management, community and public health settings; prepares for graduate school and certification; basic programs are 4 years; mobility options may be only 2 years *master's degree in nursing (MSN)* institution: universities length: 1 to 2 years beyond BSN degree; some offer fast-track options purpose and scope: advanced clinical practice, management, education, leadership positions *doctoral degree in nursing* institution: universities length: varies; PhD, DSN, DNP, DNSc purpose and scope: advanced nursing for research, clinical practice, education, and leadership positions

diversity in nursing education programs

professional nursing role: - health promotion and health maintenance, and management of disease conditions - encourage clients to look at alternatives, recognize their choices, and develop a sense of control in a rapidly changing health care environment

educator and counselor

*key functions:* 1. health information and data capture - information to make sound clinical decisions such as past medical history, lab tests, allergies, current medications, and consent forms 2. results/data management - electronic reports of laboratory results and radiology procedures with automated display of previous results 3. provider order entry management - computerized provider order entry with or without decision support to eliminate lost orders and illegible handwriting 4. clinical decision support - provides reminders about preventive practices, such as immunizations, drug alerts for dosing and interactions, and clinical decision making 5. electronic communication and connectivity among providers, health care team, and patients - radiology and laboratory personnel, and connectivity to the patient record across multiple care settings 6. patient support 7. administrative process support - scheduling systems, billing and claims management, insurance eligibility, and inventory management 8. reporting and population health management - meet public and private sector reporting requirements at the federal, state, and local levels; address internal quality improvement initiatives *CPOE contribute to medical error prevention through these elements:* - improved communication - more readily accessible knowledge - requirement for key pieces of information - assistance with calculations - accuracy checks performed in real time- assistance with medication monitoring - decision support - rapid response to, and tracking of, adverse events

electronic health records (EHR)

four sources of energy: *1. physical* - proper eating, adequate sleep and exercise, frequent breaks during long shifts (about 90 minutes), drinking water, and focusing on one activity while collecting thoughts on what to prioritize next *2. mental* - realistic optimism: seeing the world as it is, but always working toward a goal - ability to maintain sustained concentration on a task, move flexibly between broad and narrow issues, and be internally and externally focused as needed by the situation - includes mental preparation, visualization, positive self-talk, effective time management, and creativity ask:1. what are my major goals in life? 2. what is my purpose? *3. spiritual* - being in a quiet place helps us identify our vision of life - having direction and purpose - the discipline of continually clarifying and deepening one's personal vision, focusing one's energies, developing patience, and seeing reality objectively - live in continual learning mode, uncovering their personal growth areas *4. emotional* - managing emotions skillfully in the service of high positive energy and *full engagement:* emotional intelligence - improving one's self confidence, self control, self regulation, social skills, interpersonal effectiveness, empathy, patience, openness, trust, and enjoyment

energy managment

What is an example of homeopathy medicine or treatment?

essential oils

*institutional review board* - a committee that gathers to discuss research proposals and determine if the ethical rights of those participating in the research are protected - participants must sign consent to be apart of a research study - the consent must explain the study throughly and assure them of their legal rights - the participants also are notified they have the right to refuse or to withdraw from the study at any time - institutions that receive federal funding or conduct drug or medical device research regulated by the FDA are required to establish an IRB *historical situations* - a number of codes and regulations have been implemented to ensure ethical conduct in research 1. Nuremberg Code 2. Declaration of Helsinki - developed in response to unethical acts such as the Nazi experiments - Tuskegee syphilis study: initiated by the U.S Public Health Service for 40 years - African-American men were not informed about the purpose and procedures of the study and did not receive treatment for syphilis - Jewish Chronic Disease Hospital: 22 patients were injected with liver cancer cells without being informed that they were taking part in the research

ethical issues related to research

a set of principles, standards, or truths on which to base ethical actions - common ground is established between the nurse and the patient *autonomy* - the principle of respect for a person - people are free to form their own judgments and whatever actions they choose *beneficence* - to promote goodness, kindness, and charity - provide benefits to to others by promoting their good *nonmaleficence* - duty not to inflict harm - abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats *veracity* - telling the truth

ethical principles

patient care in which staff members are assigned to complete certain tasks for a group of patients rather than care for specific patients - emergency departments - daily care tasks in long-term care settings ex. LVN/LPN: oral medications and treatments RN: assessments and care plans nurse aid: vital signs and hygiene pros: - patient care is provided in an economic and efficient manner because less - skilled, lower - cost workers are used - minimum number of RNs is required- tasks are completed quickly cons: - care may be overlooked because different workers only focus on their tasks - patient may feel confused with different individuals - caregivers may feel unmotivated when performing repetitive functions

functional nursing

*1. register to vote and vote in all elections* - informed voting: reading legislative newsletters and finding out about policymakers' backgrounds, voting records, and current party and candidate platform - identify and elect "nurse-friendly" candidates *2. joining professional nursing organizations with policy advocacy agendas* organization strategy - ANA, C/SNAs, organizational affiliates- able to have more resources and pool their strengths - *ANA:* speaks for all professional nurses - *PAC:* an arm of a corporation, association, or union formed to provide support and resources to work toward the election of policymakers who support the organization's overall goals or policy- endorsement: selecting a particular candidate to support *3. working on political candidates' campaigns* - nurses can educate candidates about health care issues - assist in writing health care position statements, workin gin campaign offices, attending local debates, displaying political buttons, signs, stickers, and participating in fundraising events - may also contact other nurses and ask for their vote *4. meeting with policymakers or their staff members* - face-to-face contact provides opportunity to educate while enhancing the image of the nurse *5. attending and speaking up at "meet the candidates" town hall meetings* - town hall gatherings allow candidates to talk about their platform and for nurses to voice their experiences, opinions, and concerns about health care issues *how to host* 1. before the town hall meeting, become familiar with each candidate's background 2. identify current issues that would be relevant for discussion 3. prepare to give concise examples of how the issue affects members 4. plan the agenda for the meeting to allow amply time for discussion 5. after introductions are made, listen carefully as each candidate presents their campaign platform and then be prepared to discuss the issues with relevant examples 6. at the conclusion, provide the candidate with contact information for key members of your group *6. communicating with policymakers by e-mail, fax, and telephone* - should be made early before policymakers publicly commit to a certain policy option- send a follow-up communication immediately before the vote on a bill is scheduled guidelines: 1. be brief: short, direct e-mail and faxes are the most effective 2. be specific: deal with just one subject 3. be personal 4. provide your name and address 5. be persistent

grassroot political strategies

*1. assessment:* collecting information and understanding the information *2. analysis and diagnosis:* analyzing the information and identifying the fundamental issue or underlying problem that needs to be addressed *3. planning:* developing options for an effective policy plan and involved input from many sources and perspectives *4. implementation:* requires political action and a set of strategies and strategic interventions *5. evaluation:* assessing evidence that determines the success of the intervention

health policy and the nursing process

a set course of action undertaken by governments or health care organizations in order to achieve a particular health outcome - to successfully achieve the development of health care policies for the future *local health policy* health policy that only applies to people who are residents of that local community - many cities or counties offer a variety of health care services to meet the needs of their residents - requirement for tobacco-free public areas such as restaurants and office buildings - provides public health programs - free or reduced-rate immunizations offered to all children in the community - allocating funds to employ RNs as school nurses in public schools - safe drinking water, enforcement for seat belt and child restraint laws, and emergency medical systems *state health policy* - health policy that applies to the state population - lead role is to govern nursing and other health professions' scope, practice, and performance through professional practice acts - policies include maintaining a safe meat supply through livestock inspections, ensuring safe food storage, preparation, and serving in restaurants - ensures that health care facilities provide safe, quality, care through regulatory compliance - critical in cases of E. coli outbreaks - involves paying for some individual health care services - *Medicaid:* a health insurance program for health care services for eligible people at or below a specific income level and other categories *- Children's Health Insurance Program (CHIP):* provides health insurance coverage to uninsured children who do not qualify for the state Medicaid program- with state, funds for public mental health and substance abuse services, long term care services for older adults, and disabled persons, and prisoners - accepts and rejects the Medicaid Expansion provisions of the PPACA - *State Health Insurance Exchanges (SHIE):* a set of state-regulated and standardized health care plans from which individuals may purchase health insurance eligible for federal subsides *federal health policy* health policy that applies to all residents in the United States - passed the PPACA by the 111th Congress- significant funding for health and disease prevention and research, supplemental funding for education for health professionals, and paying for individual health care services through Medicare, Medicaid, CHIP, Veterans Administration, and Indian Health Services care systems - first to provide funding for nursing services was the *Sheppard-Towner Act of 1921:* provided states with matching funds to establish prenatal and child health centers staffed by public health nurses; goal was to reduce maternal and infant mortality rates by teaching women about personal hygiene and infant care (reinstated within title V of the Social Security Act of 1935) - *Hill-Burton Act of 1950:* provided funding to local communities that resulted in a boom in the construction of hospitals across the country - expanded Medicare and Medicaid reimbursement - implemented policies and programs to expand the nursing supply through all education levels from BSN, to DNP, and PhD

healthy policy

care that focuses on the comfort for the patient and family at the end of life - management of physical emotional, and spiritual needs - derived from hospitality - begins with prognosis of 6 months or less focus: to address the specific needs of the dying patient and their family services: routine home care, respite care, general inpatient care, continuous care home, nursing home, residential, hospice, inpatient (on designated unit or designated beds)

hospice care

infection control: assesses the total incidence of infections within the hospital; conducts a thorough analysis to determine the source of the infection and its onset quality management: ensure that outcomes in client care services and consistent with established standards specific client services: provides support and interventions with the insertion and maintenance of intravenous therapies coordinator positions: responsible for the coordination and integration of the clinical and administrative requirements of the trauma victim

hospital opportunities (nurses today)

the set of skills needed to find, retrieve, analyze, and use information 1. defines and articulates the need for information 2. accesses needed information effectively and efficiently 3. critically evaluates the procured information and its sources, and as a results, decides whether or not to modify the initial query and/or seek additional sources and whether to develop a new research process 4. individually or as a member of a group, uses information effectively to accomplish a specific purpose 5. understands many of the economic, legal, and social issues surrounding the use of information and accesses and uses information ethically and legally

information literacy

nurse (RN): often the coordinator of the team physician (MD or DO): often the leader of the team; diagnoses and prescribes treatment interventions for clients pharmacist (RPh or PharmD): responsible for providing drug therapy for positive client outcomes physician assistant (PA): works under the supervision of the MD or DO and performs assessments, procedures, or protocols approved by the physician dietitian (RD or LD): provides nutritional therapy and support to ensure that the nutritional needs of the client are met physical therapist (PT): attends to the client's needs for movement; assess physical strength and mobility needs speech-language pathologist (SLP): assists clients who are communicatively impaired by intervening in speech, language, and/or swallowing disorders related to language occupational therapist (OT): plans activities that assist and teach clients with physical disabilities to become independent in activities of daily living, such as dressing, grooming, bathing, and eating respiratory therapist (RT): responsible for assessment and maintenance of the client's airway and respiratory equipment used for diagnosis and therapy of respiratory disorders social worker: uses skills to help clients, families, and communities address psychosocial needs chaplain or pastoral representative: attends to the spiritual and emotional needs of the client and family

interprofessional health care team members

health care team composed of professionals from different disciplines

interprofessional team

*Florence Nightingale:* - Founder of professional nursing Honored for her contributions to nursing research - Established the first nursing school in England - Honored as the founder of professional nursing services, initiated social services, spent up to 20 hours each day providing nursing care - Introduced principles of asepsis and infection control, a system for transcribing physician's orders, and a system to maintain patient records - Kept careful statistics—documented a decrease in the death rate of soldiers from 42% to 2% as a result of health care reforms that emphasized sanitary conditions *Mary Seacole:* - Jamaican nurse who cared for the sick in a lodging house in Kingston - wrote to the British government requesting to join Nightingale's group fo nurses but was denied because she was black - purchased her own supplies and moved to Crimea where she opened a lodging house for the soldiers during the Crimean War *Dorothea Dix:* - appointed to organize military hospitals, provide trained nurses, and disperse supplies - received no official status and no salary *Harriet Tubman:* - cared for wounded soldiers and conducted an "underground railroad" to lead slaves to freedom *Sojourner Truth:* - known for her abolitionist efforts, as well as her nursing efforts, was an advocate of clean and sanitary conditions so patients could heal *Susie King Taylor:* - although hired in the laundry, worked full time as a nurse on the battlefront with no pay or pension; not considered an official Union Army nurse - taught many how to read and write *Clara Barton:* - served on the front line during the Civil War and operated a war relief program; credited founding the American Red Cross *Louisa May Alcott:* - authored detailed accounts of the experiences encountered by nurses during the war for a newspaper publication entitled Hospital Sketches *John D. Rockefeller:* - white philanthropist, funded the establishment of the first school of nursing for black women now known as Spelman College

key people

professional nursing role: - improving the health status and potential of individuals or families - ensuring that safe, high-quality care is provided across all health care settings - increasing the effectiveness and level of satisfaction among professional colleagues providing care - managing multiple resources in a health care facility - elevating citizens' and legislators' attitudes toward and expectations of the nursing profession and the health cares system and - planning, giving direction, and monitoring and evaluating nursing care of individuals, groups, families, and communities

leader and manager

*professional nurses are expected to have the following leadership and management skills:* - make good clinical decisions - promote evidence based practices - lead quality improvement initiatives - coordinate patient care activities - promote team morale and patient satisfaction - support compliance with regulations and accreditation standards *formal:* practiced by the nurse who is appointed to an approved position and given the authority to act by the organization *informal:* exercised by the person who has no official or appointed authority to act, but is able to persuade and influence others *management:* coordination of resources (time, people, supplies) to achieve outcomesy

leadership and management

*1. autocratic/authoritative* - determines policy and makes all decisions - ignores subordinates' ideas or suggestions - dictates the work with much control - gives little feedback or recognition for work - makes fast decisions - successful with employees with little education or training *2. democratic/participative* - encourages staff participation in decision making - involves staff in planning and developing new ideas and programs - believes in the best in people - communicated effectively, and provides regular feedback - builds responsibility in people - works well with competent, highly motivated people *3. laissez-faire* - does not provide guidance or direction - unable or unwilling to make decisions - does not provide feedback - initiates little change - communicates by memos or e-mail - may work well with professional people

management styles

a requirement that all nurses must be licensed after each state had established permissive licensure - New York was the first state - nursing groups moved to standardize nursing licensure testing procedures after World War II, the ANA formed the NCSBN - council advocated a standardized examination for licensure - the National League for Nursing administered the first State Board Test Pool Examination in 1950 - included medical-surging nursing, maternity nursing, nursing of children, and psychiatric nursing 1982: development of the first NCLEX-RN examination - revised to include all nursing content within one section of the examination - format was changed to present questions in a nursing process format - paper-and-pencil testing was replaced with computerized adaptive testing

mandatory licensure

Which CAM therapy can be beneficial for reducing edema, promoting circulation and respirations and relieving pain and anxiety?

massage/touch therapy

what can acupuncture help cure?

nicotine withdrawal, asthma, stroke rehabilitation, and carpal tunnel syndrome

also called care delivery system or patient care delivery model; details the way work assignments, responsibility, and authority are structured to accomplish patient care - depicts which health care worker is going to perform what tasks - who is responsible - who has the authority to make decisions 1. total patient care 2. functional nursing 3. team nursing 4. primary nursing

nursing care delivery models

system of principles concerning the actions of the nurse in his or her relationship with patients, patients' family members, other health care providers, policymakers, and society as a whole - Gallop Poll of 2016 - public ranks nursing as the most ethical of all professions and has done so for two decades - nursing code of ethics first brought about in the late 19th century code of ethics: provide implicit standards and values for the professions box 9-1 and box 9-2

nursing ethics

found within art and literature is the eternal question: "Can I trust and entrust my life to this nurse?" *Antiquity Image of Nursing:* - nurses were imaged as untrained servants, soldiers, women of religious orders, or wealthy people performing acts of Christian charity *Victorian Image of Nursing:* - nursing was endured because of the lack of other opportunities - nursing provided a way to profit from the sick and dying - Charles Dickens' portrayal of Sairey Gamp, the drunken, physically unkempt, and uncaring nurse *Early Twentieth-Century Nursing:* - nurses in war settings captured the attention of artists - heroic nursing *The 1930s Nurse as Angel of Mercy:* - nursing is a holy vocation, nurses have professional credentials, and their career choice is opposed because popular opinion held that women belong at home - In 1936, Warner Brothers' movie "The White Angel" chronicled the professional life of Nightingale; it was endorsed by ANA in 1992 - In 1938, a tall, white, imposing statue, the Spirit of Nursing was placed in Arlington National cemetery to honor military nurses *The 1940s Nurse as Heroine:* - Nurses were commemorated as war heroes through movies, stamps, and the naming of a U.S. Navy destroyer for a Navy nurse, the USS Higbee - nursing continued to be glamorized through romance novels *Nursing in the Antiestablishment Era of the 1960s:* - Television shows: nurse as a background figure to physicians Movies: nurse as a power figure who cruelly punished patients - Nurse Ratched - starched white uniform that punished patients to cure their psychosis *Nursing in the Sexual Revolution of the 1970s:* - Media portrayed nurses negatively—uncaring nurse in M*A*S*H - One positive image was the commemorative stamp of Clara Maass, who died after deliberately obtaining two carrier mosquito bites so she could continue providing care to soldiers with yellow fever during the Spanish-American War *Nursing in the 1980s to 1990s:* - focused on caring - fatigue of the nurse and her care for this dying soldier - Miss Evers' Boys - Love and War - Vietnam War Women's Memorial

nursing in art and literature

*More women entered into nursing* - New shifts (10 and 12 hour) *Growing concerns about the health of the nation* - Healthy People 2000 initiative - Increasing focus on health promotion and disease prevention activities *Influence of the AIDS epidemic* - New procedures for infection control were required Universal Precautions were mandated *Exposure to hazardous materials* - Workplace chemicals and radioactive substances created health risks - Employee training was instituted across all industries *Managed care movement* - Focus moved from acute care to prevention and primary care - Emphasis on outpatient, ambulatory, and home services - Massive downsizing of hospital nursing staff and increase in unlicensed assistive personnel - Increasing demand for community health nurses and advanced practice nurses *Changing nursing requirements for the 1990s and beyond* - Focus on health risk assessments based on family and environmental issues - Focus on health promotion and disease prevention - Promote counseling and health education

nursing in the 1990s

1. traditional duties and responsibilities of the professional nurse, regardless of practice area or setting 2. duties and responsibilities of the professional nurse that are guided by specific professional standards of practice and usually carried out in a distinct practice area

nursing roles

what is the most common reason for seeking acupuncture therapy?

pain relief

*Dr. Balfour Mount* an approach that improves the quality of life of patients and their families who are facing serious illness - pain and symptom management and support by a team in making health care decisions - begins at the time of diagnosis of a serious illness *HPNA defines a palliative nurse as one who:* - provides age-appropriate culturally, ethically, and spiritually sensitive care and support - maintains a safe environment - educates patients/families to identify appropriate settings and treatment options- ensures continuity of care and safe transitions to the next appropriate setting - coordinates care across settings and among caregivers - manages information and protects confidentiality *steps of palliative care* 1. begins with diagnosis of a patient 2. continues to death 3. followed by continued support of the family focus: to address the specific needs of patients and families experiencing serious illness

palliative care

a cornerstone of the nursing profession, and patients depend on nurses to ensure that they receive proper care whistle-blower protection: legislation that seeks to prohibit health care organizations from retaliating against nurses when disclosing information in good faith

patient advocacy

*standards that regulatory and accrediting agencies developed to promote patient safety* 1. sentinel event - an unexpected occurrence involving patient death or serious physical or psychological injury or the risk thereof - includes loss of limb or function - signal the need for immediate investigation and response 2. national patient safety goals: 1. identify patient correctly 2. improve staff communication 3. improve the safety of using medications 4. reduce the harm associated with clinical alarm systems 5. reduce the risk of health care-associated infections 6. the organization identifies safety risks inherent in its patient population 7. universal protocol for preventing wrong site, wrong procedure, wrong person surgeries. 3. never events: serious adverse events during an impatient stay that should never occur or are reasonably preventable through adherence to evidence-based guidelines

patient safety

- Rapid changes over the past 100 years - Minorities are accounted for more than half of the population at times - By 2044 the now minority groups are expected to become the majority - Nation set to be a 54% minority by 2050 - by 2023 minorities will count for half of all of the children - Our nation is getting older 2030 older adults will count for roughly 20% of the population Federally Defined Minority Groups: - Asian American - Black of African America - Hispanic or Latino - Native Hawaiian and other Pacific Islander - American Indian and Alaska Native

population trends

- nurses and students have posted comments about their practice, managers, or patients that have created serious professional issues for nursing - 33 state boards of nursing reported receiving complaints about nurses' use of social media - 26 of these SBNs reported having disciplined the licenses of nurses - nurses have "friended" patients and their families - posting pictures of patients on a social media site - nurses can positively use electronic social media to share workplace concerns or events for support and guidance, but must always be mindful of not providing names, explicit details or patient identifiers, including photos, to protect patient and nurse privacy

portrayal of nurses through social media

disaster phase in which activities are focused on planning, prevention, and warning - activities that build capability and capacity to address potential needs identified by the threat and vulnerability study *key elements of a community preparedness program* 1. assessing the community for risks and determining the types of events that may occur 2. planning the emergency activities to ensure a coordinated response effort 3. building the capabilities that are necessary to respond to the consequences of the events

preparedness

patient care in which the RN, or "primary nurse" assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge - long-term care settings pros: - one-to-one relationships between nurse and patient - nurses are able to practice feeling challenged and rewarded cons: - the primary nurse is required to practice with a high degree of responsibility and autonomy - clinical judgement and critical thinking is necessary - the number of nurses required may be difficult to recruit and prove to be more costly for the organization

primary nursing

occurs when a person prepares for a profession, enters the profession, and then finds that he or she is not prepared phases: *1. honeymoon phase* - everything is just as the new graduate imagined- new nurse is in orientation with former school friends or other new graduates ex. "I'm so glad I chose nursing" *2. shock (rejection) phase* - orientation is over, and the novice nurse begins their assigned unit - receives daily assignments and begins the tasks - comes into contact with conflicting viewpoints and different ways of performing skills, but lacks the security of having an expert available to explain gray areas- "sink or swim" - novice may be frightened or react by isolation - may experience feelings of rejection and a sense of lack of accomplishment 1. what must i do to become the kind of nurse i want to be? 2. what must i do so that my nursing contributes to humankind and society *3. recovery phase* - the return of humor or desire to succeed - novice nurse begins to understand the new culture to a certain degree - less tension and anxiety, and healing begins *4. resolution phase* - the result of the shock phase combined with the novice nurse's ability to adjust to the new environment - work expectations are more easily met, and the nurse has the ability to elicit change

reality shock

The process of imagery helps a client establish what desired outcomes? Check all that apply. 1) Relieve stress 2) Increase blood pressure 3) Enhance circulation 4) Decrease blood pressure

relieve stress, enhances circulation, and decrease blood pressure

- the federal government and states seek to protect at risk individuals (children and older adults) by requiring nurses and other health care providers to report specific types of suspected or actual patient-client injury, abuse, or neglect - some states have enacted statutes that mandate nurses to report unsafe, illegal, or unethical practices

reporting statutes

professional nursing role: - assisting with data collection, critiquing research findings, and using these findings in practice

researcher

*science:* a method of bringing together facts and giving them coherence and integrity - is dynamic in figuring out how a phenomenon happens - is static in describing what happens *the five steps of the scientific process:* 1. hypothesis: ask the question that is to be the main focus - dependent and independent variables 2. method: decide what data will be collected to answer the question - decide on and identify the step-by-step procedure that will be used to collect these data - make sure this process can be easily replicated 3. data collection: implement the step-by-step process that has been determined to answer the question 4. results: on the conclusion of the data collection, statistically identify the outcomes - establish parameters (level of significance) that will determine whether the data are relevant 5. evaluation: examine the results to determine the relevance of outcome data in answering the hypothesis - determine the significance and identify the potential for future research *nursing theory*: the conceptualization of some aspect of nursing reality communicated for the purpose of describing phenomena, explaining relationships between phenomena, predicting consequences, or prescribing nursing care - applies more to a specific area of the larger scientific process *criteria for theory acceptance* 1. inclusiveness: does the theory include all concepts related to the area of interest? 2. consistency: can the theory address new entities without having its founding assumptions changed? 3. accuracy: does the theory explain retrospective occurrences? does the theory maintain its capacity to predict future outcomes? 4. relevance: does the theory relate to the scientific foundation from which it is derived? it is reflective of the scientific base? 5. fruitfulness: does the theory generate new directions for future research? 6. simplicity: does the theory provide a road map for replication? it is simple to follow? does it make sense?

science and theory

*military and government nurses* - not necessary for these nurses to obtain a nursing license in each jurisdiction - takes the NCLEX in one state - may practice in other jurisdictions without additional licensure requirements - should obtain the current requirements for licensure as rules are updated to reflect current practices *internationally educated nurses* - have met the requirements for practice in those countries - when moving to the U.S, they must show evidence of completing their original educational program and restrictions of their license - nurses need to demonstrate competency in English and the ability to pass the NCLEX - foreign nurses take a special examination administered by the Commission on graduates of Foreign Nursing Schools - may apply for a license to practice in the US - regulations are for the protection of the public and the title of RN *international practice* - nurses wanting to practice in other countries must contact either the International Council of Nurses or the nursing regulatory board of the country in which they wish to practice - must be prepared to submit documentation on education, NCLEX results, and proof of licensure and practice to officials in the foreign country

special cases of licensure

ensuring that an adequate number and mix of health care team members are available to provide safe, quality patient care *patient classification system* method used to group or categorize patients according to specific criteria and care requirements and thus help quantify the patient acuity *patient acuity* indication of the amount and complexity of care required for any particular patient *staffing systems must* 1. address individual patient care needs 2. incorporate clinical competencies of nurses and other team members to provide care 3. reflect the value of RNs as vitally important to the organization 4. provide nurses time to exercise professional judgement and acknowledge that patient needs can change *several specific considerations regarding staffing are reviewed related to:* 1. patient needs 2. nursing characteristics 3. organizational needs and the practice environment *the three basic organizational needs that are significantly affected by staffing are:* 1. financial resources 2. licensing regulations and accreditation 3. customer satisfaction *ANA recommends that classification systems should consider patients':* - age and functional ability - complexity of care needs- communication skills - cultural and linguistic diversities - severity and urgency of the admitting condition - scheduled procedures - ability to meet health care requisites - availability of social supports - other specific needs identified by the patient and by the RN *the nurse manager is accountable for appropriately managing staffing to stay within budgetary guidelines for:* - number of staff working at any given time to provide care to a given number of patients - staff mix, the combination of types of workers present to provide patient care

staffing

- Written by congress or state legislatures, then enacted or put into place as statutes. - Nurses must practice a due diligence of knowing the law and following it. - Being ignorant of the law is not an excuse to violate the law. - Subject to penalties (monetary fines, suspension or revocation of a license, or imprisonment)

statutory law

plans that tell a researcher how data are to be collected, from whom data are to be collected, and how data will be analyzed to answer specific research questions - research studies are classified into quantitative and qualitative *quantitative research* - formal, objective, systematic process used to describe and test relationship and examine cause-and-effect interactions among variables *quantitative research* - systematic, subjective approach used to describe life experiences and give them meaning *triangulation* - the use of various research methods or data collection tools in the same study - quantitative and qualitative designs used together *pilot studies* - small-scale studies used to identify the strengths and limitations of a planned larger-scale study - used to assess the design, methodology, and feasibility of a study

study designs

patient care in which the RN functions as a team leader and coordinates a small group of ancillary personnel to provide care to a small group of patients - medical surgical units pros: - high-quality, safe and effective care with a high proportion of support staff - each team member participates in decision making and contributes their own special expertise in care cons: - continuity of care may suffer if the team assignments vary - team leader may not have the leadership skills - insufficient time for care planning and communication

team nursing

stage 1: the nurse has few experiences with clinical expectations, and skills are learned by rote; occurs while completing the nursing educational requirements stage 2: exemplifies advanced beginners who are able to perform adequately and make some judgment calls based on experience; most novice nurses enter the workforce during this stage stage 3: includes competent nurses who are able to foresee long-range goals and are mastering skills stage 4: includes proficient nurses who view whole situations rather than parts and are able to develop a solution stage 5: includes expert nurses for whom intuition and decision-making are instantaneous

the five stages from novice to expert

Why is biofeedback an effective CAM therapy?

the noninvasive technique allows for ease and participant control while also allowing for a larger data collection period

what is the current process for licensing or certifying Ayurvedic practitioners?

there is no current process

1. require hospitals to have a nurse-driven staffing committee to create staffing plans that reflect the needs of the patient population and match the skills and experience of the staff - 7 states 2. require facilities to disclose staffing levels to the public and/or a regulatory body - 5 states 3. enact legislation to mandate specific nurse-to-patient ratios - only California

three general approaches to ensure sufficient nurse staffing have been utilized at the state level:

*1. planning* - most important step - allows people to better use their time and can lead to closure in relation to those goals that will produce the most internal satisfaction - have a priority -planning list is useful in keeping you on track to accomplish tasks by the end of the day involves: 1. setting goals and establishing priorities 2. scheduling activities 3. making to-do lists *2. organizing* - requires that you be able to deal effectively with the following: - the stacked-desk syndrome - the art of "no detourism" - the art of "wastebasketry" - e mail and memo mania *3. implementing* - refers to carrying out activities that assist people in managing time use includes: - attacking the priorities - finding "extra" time - delegating appropriately - learning the art of saying "no" - rewarding yourself - using technology

time management strategies

the oldest method of organizing patient care; sometimes referred to as case nursing - nurses are responsible for planning, organizing, and performing all care, including personal hygiene, medications, treatments, emotional support, and education pros: - patient receives holistic care by only one nurse per shift - at shift change, the RN who has provided care and the RN assuming care can easily communicate - lines of responsibility are clear cons: - nursing shortages or financial restraints - the RN performs many tasks that could be performed by a caregiver

total patient care

- in the late nineteenth century during the Industrial Revolution - workers felt the need to join together to protect themselves from circumstances such as long work hours, child labor, and unhealthy factory conditions - had goals such as: safety work situations, adequate pay for hours worked, right not to be arbitrarily dismissed National Labor Relations Act 1935: gave employees the right to self-organize, form labor unions, and bargain collectively without the fear of being fired for belonging to a union or participating in union activities National Labor Relations Board: implemented provisions of the NLRA; an independent federal agency that continues to play a vital role in labor-management relations, serves through 26 offices in the US, and conduct union elections and prosecutes unfair labor practices

trade unionism

type of leader that: - focus on day-to-day operations and are comfortable with the status quo - reward staff for desired work - monitor work performance, and correct as need - wait until problems occur, then deal with the problem

transactional leader

type of leader that: - identify and clearly communicate vision and direction - empower the work group to accomplish goals and achieve the vision - impart meaning and challenge to work - are admired and emulated - provide mentoring to individual staff members based on need

transformational leader

the abrupt shock associated with moving from student to professional nurse associated with doubt, confusion, disorientation, and loss phases: *1. stability:* - being "steady" or what is likely to change for you as a new nurse - how many nurses have left in the past year? - what are the staffing levels? - what are the acuity and average length of stay for patients? - are any socialization activities planned? - do people like working here? - what does a routine day look like on this unit? *2. predictability:* - knowing with some certainty the types of patients you will encounter, who is staffing the unit, and what your work schedule will be *3. familiarity:* developing routines and becoming familiar with the staff and layout of the unit *4. consistency:* - "sameness" - whether you can expect similar types of patients and staff

transition shock

types of program and credential: *rapid knowledge expansion; increasing use of technology and informatics in education and practice:* 1. choosing the most effective electronic and technology options 2. information overload' virtually unlimited global resources, global research opportunities, issues 3. identifying current and accurate information; material rapidly outdated 4. expanded expectations, limited time, rapid response expected; little time for reflection *practice-based competency; outcomes and evidence-based content:* - expansion of nursing informatics, content and skills development - learning focused on core practice competency outcomes, professional skills beyond technical psychomotor skills; core practice competencies; multiple conflicting versions: which to use? *performance-based competency: learning and objective assessment methods* - changes in standards; ensure patient safety - multiple teaching-learning methods: interactive collaborative, in-class and out-of-class projects; problem-based learning; increasing self-responsibility; accountability for learning and competence; interprofessional learning; using electronic devices, media to access resources - competency assessment based on performance examinations, specified portfolio documentation; standards-based assessment methods; emphasis on patient safety *sociodemographics, cultural, diversity, economic, and political changes:* - increased aging population; increasing multicultural, ethnic diversity requires increased learning, respect for differences, preferences, customs; generational issues - immigration conflicts, protests; consequences for access and health care - community, faith-based projects, service-learning projects - social, economic, and political changes influence health care delivery and access to clinical experiences; influence disrespect, conflict, abuse, violence; increased poverty and need *community-focused interdisciplinary approaches:* - interprofessional collaborative learning - diverse alternative health practices, influence of cultures - broad scope of nursing; clinical approach; increasing use of diverse experiences throughout community; continuum from acute care to health promotion; from hospitals to home to rural to global settings - requires more planning, travel time, expenses, arrangements; different skills, communications; critical thinking, problem-solving strategies - multiple teachers, preceptors, staff instructors, part-time, with varying abilities; time constraints *global health:* - extensive global travel and commerce - illness can arrive on any airplane, ship, or bus and spread throughout the country - threat of epidemics - nurses are connected globally through shared networks and technology *patient-centered care: engagement, safety, and privacy:* - all expect value, quality, individual respect, consideration, attention; privacy issues - patient initiatives for involvement and protection; balance standards and preferences - increased litigation, medical-nursing errors; focus on safe, competent patient care - increased individual responsibility, accountability for learning and practice *ethics and bioethical concerns:* - alternative solutions to ethical dilemmas; issues regarding diverse beliefs, disputes regarding biotechnology and bioegineering in health care - many gray zones instead of black-and-white absolutes; separate professional practice responsibilities form personal opinions, consequences for competence, and patient safety - integrate into professional practice acceptance of the individual's right of choice regarding life and death issues, health care methods; respect, tolerance for patient's decisions, ethical competencies for students - standards of quality care, patient's right issues *increasing shortage of nurses and faculty:* - shortage of staff results in limitations in clinical learning; heavy workload; using preceptors, part-time instructors; less one-to-one help for students; consequences for learning and patient safety - shortage of qualified faculty; aging, retiring; increased part-time instructors, clinical staff, national and global problems, influence quality education and future nursing staff; need for increased educational funding - students need more clinical learning; more responsibility for self-directed learning, seek assistance from others - increased use of simulation; required to validate initial and continuing competence *disasters, violence, and terrorism:* - new learning skills required for major natural disaster events; new program options, new courses, and new skills needed for emergency responders - violence in society, homes, workplace, schools; abuse against women and children - preparedness for terrorism; skills, programs for first responders; increased anxiety, uncertainty *increasing professional and personal responsibility:* - lifelong learning to meet professional expectations; certification requirements - increasing competency assessment in workplace - changes in standards for quality care practice - high stress from competing demands of school, home, meeting competency requirements

trends and issues in contemporary nursing education

1. operating - allocates funds for daily expenses, such as salaries, utilities, repairs, maintenance, and patient care supplies 2. labor - is a subset of the operating budget; allocates funds for salaries, overtime, benefits, and staff development and training 3. capital - allocates funds for construction projects and/or long-life medical equipment, such as cardiac monitors, defibrillators, and computer hardware

types of budgets

what are some conditions that biofeedback can offer benefit?

urinary incontinence, anxiety, stress, irritable bowel syndrome, neck and back pain, and cardiac arrhythmias

hospice nurse: treat the symptoms of those with progressive terminal disease; maximize the quality of life rather than focus on the quantity of life remaining informatics nurse specialist: focuses on management and processing of health care information; include working as researchers, consultants, managers, educators, and product and web designers occupational health opportunities: designs and implements a program of health promotion and disease prevention for employees and assists with immediate health needs as necessary quality manager: assess opportunities for process improvement, implement changes, measure outcomes, and then start the improvement process all over again; research and describe findings and look for opportunities to improve care case manager: coordinate resources to achieve health care outcomes based on quality, access, and cost flight nurse: include military and civilian; fast-paced diverse practice in an unstructured setting telephone triage nurse (telehealth nurse): uses technology to provide health services by various telecommunication tools; interact with clients through telephones, video devices, or computers to assess needs, intervene, and evaluate patient care forensic nurse: applies nursing science to public or legal proceedings in the scientific investigation and treatment of trauma and/or death of victims of violence, abuse, criminal activity, and traumatic accidents school nurse: generalists prepared at the baccalaureate level who function as consultants or coordinators; facilitate positive student responses to normal development, promote health safety travel nurse: for the person who wants to travel and still work as a nurse faith community nurse: addresses holistic health promotion for oneself, others, and the community within the beliefs, values, and practices of various faiths, countries, and cultures nursing educator: competent in clinical practice either at the advanced generalist or specialist level; leadership in curriculum development, instruction, and evaluation`

variations on traditional roles in nursing

*verbal* most common form of interpersonal communication and involves: - talking and listening - tone or inflection - concept of attitude *nonverbal* communication that involves many factors that either confirm or deny the spoken word - facial expressions - eye contact - posture - body movement most communication is 55% nonverbal, 38% vocal signals (tone, pitch, or pace) and only 7% the actual words we say - "silent messages"

verbal vs nonverbal communication

a focus based on how a nurse reacts to conflicts within the workplace and continues to advocate to improve patient care *ecosystem model* 1. staffing - refers to job assignments including the volume of work assigned to individuals, the professional skills required for particular job assignments, the duration of experience in a particular job category, and work schedules 2. workflow design - pertains to on-the-job activities of health care workers, including interactions among workers and the nature and scope of their work 3. personal/social factors - refer to individual and group factors, such as stress, job satisfaction and professionalism, in addition to skills that may be underdeveloped in the nursing population, such as financial literacy 4. physical environment - includes aspects of the workplace, such as light, aesthetics, and sound - these elements will be crucial to address the needs of a maturing workforce and offer solutions to health care employers 5. organizational factors (culture) - refers to structural and process aspects of the organization as a whole, such as the use of teams, divisions of labor, shared beliefs, and an increasing leadership capacity among nurses

workforce advocacy

*4 key hazards:* 1. bloodborne pathogens - nurses are at major risk for exposure to bloodborne disease - hepatitis B, hepatitis C, and HIV-AIDS - Occupational Safety and Health Administration's bloodborne pathogens standard - Needlestick Safety and Prevention Act 2. ergonomic injuries - individuals working in healthcare experience muscular skeletal disorders (MSDs) that resulted in days away from work at a rate 56% higher than all private industries - ranked 2nd for physical work intensity - nurses have left due to back injuries- has been a shift toward evidence -based programs that create no-lift policies, secures appropriate safe patient handling and mobility technology, and trains staff on usage - Safe Patient Handling and Mobility Interprofessional National Standards - Occupational Safety and Health Administration's Standard 3. violence and incivility - acts of verbal and nonverbal aggression have caused psychological distress severe enough to cause some nurses to leave the profession 4. fatigue - nurses may work long and variable hours forgoing adequate rest and sleep, resulting in fatigue- shift work and long hours have been linked to a multitude of health related disorders - diabetes, cardiovascular disease, depression, sleep disturbances, and physical injuries- no more than 4o hours in one week, and 12 hours in one shift

workplace safety

Who first started Tai Chi and who first started yoga?

The Chinese started Tai Chi, and Hindus/India first started yoga

What benefits do both Tai Chi and Yoga have in common?

They both have an improved sense of self and help reduce stress.

a financial plan for the allocation of the organization's funds and a control for ensuring that results comply with their plan *basic functions* 1. planning - most important function of the budget planning process - set goals - identify resources - predictions - assumptions 2. coordinating and communicating - requires many different groups within an organization to come together to discuss the resources necessary to accomplish the goals of a business unit 3. monitoring progress - the nurse manager will be most involved with on a daily basis - allows timely corrective action 4. evaluating performance - characterized by accountability and compliance - manager's performance on budget results

budgeting

professional nursing role: - collaborative practice relationships among several disciplines of health care professionals - bring in-depth and specialized knowledge and skills to the interaction process - health care plans are determined through the communication of ideas and opinions of team members

coordinator of the interprofessional health care team