INTRO: Nature of Nursing: Module 1 Exam ALL

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 advocacy in the care of individuals, families, communities, and populations"

Problem-Focused Diagnosis

"A clinical judgment concerning an undesirable human response to a health condition/life process that exists in an individual, family, group or community"

Evidence Based Practice

Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Examples: Demonstrate knowledge of basic scientific methods. Appreciate strengths and weaknesses of scientific bases for practice. Appreciate the importance of regularly reading relevant journals.

What are some examples of Necessary Activities for Professional Behavior?

Integrates ethical behavior in nursing practice. Performs activities safely, so as not to injure or harm others. Interacts respectfully with peers, superiors, and patients. Capacity to engage in successful conflict resolution. Recognizes that as a student they represent the nursing profession, and must behave accordingly. Respects and adheres to the policies and procedures of the College, ADN Program and clinical agencies. Reflects on personal behavior and practice performance with patients, engages in self-evaluation. Refrains from disruptive behaviors as described in the Temple College Student Handbook including sleeping in class, belligerent attitude, ignoring instructor's directions, talking at inappropriate times, use of unauthorized personal devices (ex gaming, browsing the internet, texting, listening to music, etc.)

___________ variables such as patient perceptions of symptoms and the nature of the illness influence patient behavior.

Internal

Safety

Minimize risk of harm to patients and providers through both system effectiveness and individual performance. Examples: Examine human factors and basic safety design principles and commonly used unsafe practices. Value own role in preventing errors.

Health Promotion Nursing Diagnosis

A clinical judgment concerning motivation and desire to increase well-being and to actualize health potential. These responses are expressed by a readiness to enhance specific health behaviors, and can be used in any health state. Health promotion responses may exist in an individual, family, group, or community

contextual thinking

A major component of critical thinking in any situation is to always consider the context in which the situation is occurring. This is called

Quality Improvement

Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Examples: Use tools such as flow charts and diagrams to make process of care explicit. Appreciate how unwanted variation in outcomes affects care. Identify gaps between local and best practices.

Informatics

Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Examples: Navigate an electronic health record. Protect confidentiality of protected health information in electronic health records.

Risk Factor

any situation, habit, or other variable such as social, environmental, physiological, psychological, developmental, intellectual, or spiritual that increases the vulnerability of an individual or group to an illness or accident.

Self-guided thinkers

are independent thinkers who are able to explain their thinking, determine what thinking needs to be employed in a particular situation, then apply their thinking to arrive at a sound decision.

Nursing sensitive outcomes

are patient outcomes and nursing workforce characteristics that are directly related to nursing care such as changes in patients' symptom experiences, functional status, safety, psychological distress, registered nurse (RN) job satisfaction, total nursing hours per patient day, and costs

Your practice needs to be based on _________ _____________, not just according to your education and experiences and the policies and procedures of health care facilities

current evidence

__________ or situation-specific theories bring theory to the bedside by focusing on specific types of patients in specific situations.

practice

The __________ is the perspective or territory of a profession or discipline

domain

graduate education era

early versions of nursing theories were developed that offered more structure to nursing research

As an ____________ you explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient's progress in learning

educator

The American Nurses Associate (ANA) Code of Ethics

establishes the ethical standard for the profession and provides a guide for nurses to use in ethical analysis and decision-making. The Code is nonnegotiable in any setting.

External variables influencing a person's health beliefs and practices include

family practices, psychosocial and socioeconomic factors, and cultural background.

_____________ serves to inform a system about how it functions. For example, in the nursing process the outcomes reflect the patient's responses to nursing interventions.

feedback

Because health and illness are complex concepts, models explain the relationships between these concepts and a patient's attitudes toward health and __________ _____________

health behaviors

Improvement in health usually involves a change in

health behaviors.

Nursing incorporates

health promotion activities, wellness education, and illness prevention activities rather than simply treating illness.

_________ _________ agencies provide a wide variety of health care services with an emphasis on patient and family independence.

home care

Health promotion occurs in

home, work, and community settings.

____________ has many effects on a patient and family, including changes in behavior and emotions, family roles and dynamics, body image, and self-concept.

illness

Different attitudes cause people to react in different ways to illness or the illness of a family member; this reaction is

illness behavior

People who are ill generally act in a way that medical sociologists call

illness behavior

________ ____________ activities protect against health threats and thus maintain an optimal level of health.

illness prevention

Environment/Situation

includes all possible conditions affecting patients and the settings where they go for their health care.

Implementation Phase

includes the "carrying out" of the specific, individualized, jointly agreed on interventions in the plan of care.

Health care organizations are evaluated on the basis of outcomes such as

prevention of complications, patients' functional outcomes, and patient satisfaction.

The three levels of preventive care are

primary, secondary, and tertiary

Planning Phase

includes the identification of priorities and determination of appropriate client-specific outcomes and interventions. The nurse in collaboration with the client and family (as applicable) and the rest of the health care team must determine the urgency of the identified problems and prioritize client needs.

A person's state of health, wellness, or illness depends on

individual values, personality, and lifestyle.

Quality and Safety Education for Nurses (QSEN)

initiative is the commitment of nursing to the competencies outlined in the Institute of Medicine report related to nursing education. QSEN encompasses six competencies: patient-centered care, teamwork, collaboration, evidence-based practice, quality improvement, and safety.

Health beliefs, practices, and illness behaviors are influenced by

internal and external variables, and you need to consider them when planning care.

Continuing education

involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions. An example is a program on caring for older adults with dementia offered by a university or a program on safe medication practices offered by a hospital

clinical reasoning

is a cognitive process that uses formal and informal thinking strategies to gather and analyze client information, evaluate the significance of this information, and determine the value of alternative actions described this cognitive process as "thinking like a nurse."

Genomics

is a newer term that describes the study of all the genes in a person and interactions of these genes with one another and with that person's environment

Compassion fatigue

is a term used to describe a state of burnout and secondary traumatic stress

minimum data set (MDS)

is a uniform data set established by the Department of Health and Human Services. It serves as the framework for any state-specified assessment instruments used to develop a written and comprehensive plan of care for newly admitted residents of nursing facilities.

Quality Improvement

is an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy

burnout

is the condition that occurs when perceived demands outweigh perceived resources

Output

is the end product of a system; and in the case of the nursing process it is whether the patient's health status improves, declines, or remains stable as a result of nursing care.

Home Care

is the provision of medically related professional and paraprofessional services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation

secondary traumatic stress

is the trauma that health care providers experience when witnessing and caring for others suffering trauma

A ________________ ___________________ deals with issues of concern to those practicing in the profession.

professional organization

in-service education

programs are instruction or training provided by a health care agency or institution

Health ____________ activities help maintain or enhance health, whereas wellness education teaches patients how to care for themselves.

promotion

Adult Care Day Centers

provide a variety of health and social services to specific patient populations who live alone or with family in the community

conceptual framework

provides a way to organize major concepts and visualize the relationship among phenomena

Extended Care Facility

provides intermediate medical, nursing, or custodial care for patients recovering from acute illness or those with chronic illnesses or disabilities

Patients who suffer emotional and behavioral problems such as depression, violent behavior, and eating disorders often require special counseling and treatment in

psychiatric facilities

compassion fatigue consists of

secondary traumatic stress and burnout

Nurses need to be _____________, allowing them to identify their own vulnerability to secondary traumatic stress and burnou

self-aware Self care!!!!!

Also known as a borrowed or interdisciplinary theory, a _________ theory explains a phenomenon specific to the discipline that developed the theory

shared

Breaking down critical thinking into its parts means teaching students _________ critical thinking skills and strategies.

specific

Just learning the knowledge is never enough; knowing how to use that knowledge when needed in a ____________ __________ is what nurses must be able to do.

specific situation

Nursing ____________ provide the guidelines for implementing and evaluating nursing care.

standards

Reflective thinking is ______________ to learning and growing as a nurse

tantamount

Assumptions

the "taken-for-granted" statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory.

Descriptive theories

the first level of theory development. They describe phenomena and identify circumstances in which the phenomena occur

nursing responds to

the health care needs of society, which are influenced by economic, social, and cultural variables of a specific era.

Hildegard Peplau Peplau's Interpersonal Theory

the mother of psychiatric nursing; the focus of her middle-range theory includes interpersonal relations among a nurse, a patient, and a patient's family and developing the nurse-patient relationship

Define Code of Ethics

the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients

content

the product and information obtained from the system. For example, patients with impaired bed mobility have common skin care needs and interventions (e.g., hygiene and scheduled positioning changes) that are very successful in reducing the risk for pressure ulcers

ANA definition of nursing

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

person

the recipient of nursing care, including individual patients, groups, cultures, families, and communities

phenomenon

the term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations

clinical judgement/clinical reasoning

the thinking nurses use to make judgments about a patient situation. It is a logical process of collecting cues, processing information, under- standing the problem or situation, then planning and implementing interventions.

Theorists use definitions to communicate the general meaning of the concepts of a theory. Definitions may be

theoretical/conceptual or operational

A _________ helps explain an event by defining ideas or concepts, explaining relationships among the concepts, and predicting outcomes

theory

The twenty-first century is considered the era of

theory utilization

Without learning the building blocks of thinking in nursing, you cannot

think about your thinking but only hope your thinking is correct as you work to answer the "why" questions posed.

related factors

those that appear to show some type of patterned relationship with the nursing diagnosis. Such factors may be described as antecedent to, associated with, related to, contributing to, or abetting. Pathophysiological and psychosocial changes, such as developmental age and cultural and environmental situations, may be causative or contributing factors.

Primary prevention

is true prevention; it precedes disease or dysfunction and is applied to patients considered physically and emotionally healthy

Professional nursing organizations deal with

issues of concern to specialist groups within the nursing profession.

Critical thinking and clinical reasoning are important to transform the nursing information you are learning to useable knowledge, not...

just learning information but using information for the best possible decision

Nurses need to remain ________________ and _____________ about issues in the health care delivery system to provide quality patient care and positively affect health.

knowledgable and proactive

Compassion fatigue may contribute to what is described as

lateral violence

critical thinking

logical and realistic thoughtful judgments that are directed toward clari- fying what is true and what is false

self esteem and love and belonging are important when it comes to

long term care

acute illness

usually reversible, has a short duration, and is often severe. The symptoms appear abruptly, are intense, and often subside after a relatively short period

Children, women, and older adults are ____________ ______________ most threatened by urbanization

vulnerable populations

Nurse___________need to establish an environment for collaborative patient-centered care to provide safe, quality care with positive patient outcomes

managers

Capitation

means that the providers receive a fixed amount per patient or enrollee of a health care plan

natural healing abilities of the body incorporate complementary and alternative interventions such as

meditation, music therapy, reminiscence, relaxation, therapeutic touch and guided imagery

The ________________ of nursing identifies four concepts of interest to the profession: the person, health, environment/situation, and nursing. These four components are essential to the development of nursing theory.

metaparadigm

________________ theories address specific phenomena or concepts and reflect practice. Thus they are more limited in scope and less abstract.

middle-range

Middle-range theories

more limited in scope and less abstract. They address a specific phenomenon and reflect practice (administration, clinical, or teaching)

A ____________ _____________ manages patient care and the delivery of specific nursing services within a health care agency

nurse administrator

A ________ _________ works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments

nurse educator

The _________ ___________ conducts evidence-based practice and research to improve nursing care and further define and expand the scope of nursing practice

nurse researcher

Nightingale Era

nurses were trained to observe each patient's condition and report changes to the doctor, thus beginning the status of nursing as subservient to the physician

A working __________ ____________ may have two or three parts

nursing diagnosis

A __________ ___________ conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care

nursing theory

A _____________ ___________ conceptualizes an aspect of nursing to describe, explain, predict, and/or prescribe nursing care.

nursing theory

Reflection-ON-Action

occurs upon completion of the action. °is step is critical to improving thinking. During this step you mentally review what just happened to determine what went right and what went wrong.

Tertiary Prevention

occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration

Reflection-IN-Action

occurs while you are providing care for the patient or addressing the healthcare environment issue

Assisted living

offers an attractive long-term care setting with an environment more like home and greater resident autonomy.

An intermediate care or skilled nursing facility

offers skilled care from a licensed nursing staff. This often includes administration of IV fluids, wound care, long-term ventilator management, and physical rehabilitation.

Concepts of _________________ include respect and dignity, sharing of information, participation in care and care decisions, and collaboration

patient centered care

Providing patient- and family-centered care is a key component to

patient satisfaction

___________________ programs and public reporting of hospital quality data are designed to promote quality, effective, and safe patient care by physicians and health care organizations

pay for performance

In ____________ ______________ an organization analyzes and evaluates current performance and uses the results to develop focused improvement actions

performance Improvement

chronic illness

persists, usually longer than 6 months, is irreversible, and affects functioning in one or more systems. Patients often fluctuate between maximal functioning and serious health relapses that may be life threatening.

Nurses are becoming more

politically sophisticated and, as a result, are able to increase the influence of nursing on health care policy and practice.

What are some examples of Necessary Activities for Physical Ability?

Movement about patient's room, work spaces, and treatment areas. Administration of rescue procedures cardiopulmonary resuscitation. Lift, move, position, and transport clients without causing harm, undue pain, or discomfort to the client or one's self. Stoop, bend, squat, and reach overhead as required to safely reach equipment and provide nursing care. Correctly administer oral and parenteral medications to maintain client safety. Calibration and use of equipment. Provide or assist with activities of daily living such as bed bath, hygiene, toileting, positioning clients, making an occupied or unoccupied bed.

Using the transtheoretical model of change, in which stage is Ms. Thom most likely related to her smoking? Explain your answer.

Ms. Thom is in the preparation stage. At this time she is making small changes in preparation for a change in the next month. She has started to cut down on the number of cigarettes she smokes each day. She has also picked up materials on smoking cessation. In this stage Ms. Thom believes that the advantages of changing her behavior and stopping smoking outweigh the disadvantages. She will need assistance to plan for the change.

Which standards with the National League for Nursing (NLN) Outcomes and Competencies for Graduates of Associate Degree Programs in Nursing relate back to Emotional Stability?

NLN Human Flourishing NLN Professional Identity NLN Nursing Judgement

Which standards with the National League for Nursing (NLN) Outcomes and Competencies for Graduates of Associate Degree Programs in Nursing relate back to Communication?

NLN Human flourishing Nursing Judgement

Which standards with the National League for Nursing (NLN) Outcomes and Competencies for Graduates of Associate Degree Programs in Nursing relate back to Physical Ability?

NLN Professional Identity NLN Nursing Judgement

Which standards with the National League for Nursing (NLN) Outcomes and Competencies for Graduates of Associate Degree Programs in Nursing relate back to Sensory?

NLN Professional Identity NLN Nursing Judgement

Interpreting

Once you notice there is a problem and collect data, you must make sense of that information. You interpret what the data mean. An overall term for all the thinking skills in this step is data analysis. Nurses analyze the data using a variety of thinking skills and strategies to make sense of the data to determine issues, problems, or concerns.

PES System

P (problem)—The nursing diagnosis label: a concise term or phrase that represents a pattern of related cues. The nursing diagnosis is taken from the official NANDA-I list. E (etiology)—"Related to" (r/t) phrase or etiology: related cause or contributor to the problem. S (symptoms)—Defining characteristics phrase: symptoms that the nurse identified in the assessment.

prospective payment system (PPS)

Payment mechanism for reimbursing hospitals for inpatient health care services in which a predetermined rate is set for treatment of specific illnesses.

Which state standards with the Texas Board of Nursing does Critical Thinking relate back to?

TBON 213.29 Fitness to Practice TBON Rule 213.37 Good Professional Character TBON Rule 217.11 Standards Applicable to Professional Nurses

Which state standards with the Texas Board of Nursing does Emotional Stability relate back to?

TBON 213.29 Fitness to Practice TBON Rule 213.27 Good Professional Character TBON Rule 217.11 Standards Applicable to Professional Nurses

Which state standards with the Texas Board of Nursing does Professional Behavior relate back to?

TBON 213.29 Fitness to Practice TBON Rule 213.27 Good Professional Character TBON Rule 217.11 Standards Applicable to Professional Nurses

Which state standards with the Texas Board of Nursing does Communication relate back to?

TBON 213.29 Fitness to Practice TBON Rule 217.11 Standards Applicable to Professional Nurses

Which state standards with the Texas Board of Nursing does Physical Ability relate back to?

TBON 213.29 Fitness to Practice TBON Rule 217.11 Standards Applicable to Professional Nurses

Which state standards with the Texas Board of Nursing does Sensory relate back to?

TBON 213.29 Fitness to Practice TBON Rule 217.11 Standards Applicable to Professional Nurses

You are on the patient safety committee at your hospital. Your assignment is to identify two sources related to safety. One resource must relate to the individual nurse, and the second must relate to the practice and work environment. Identify the ANA website and use this site to identify the resources.

The ANA website is www.nursingworld.org. Sources for individual nurses are HealthyNurseTM, needle safety, and safe patient handling (http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse). A source for regarding safe practice environments is Nursing Practice and Work Environment, which includes bullying and lateral violence and safe staffing (http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse).

resource utilization group (RUG)

Method of classification for health care reimbursement for long-term care facilities.

Maintenance Stage

Sustained change over time; begins 6 months after action has started and continues indefinitely

_______ ___________ threaten health, influence health practices, and are important considerations in illness prevention activities.

risk factors

Most _______ hospitals have experienced a severe shortage of primary care providers

rural

Risk Nursing Diagnosis

"clinical judgment concerning the susceptibility of an individual, family, group, or community for developing an undesirable human response to health conditions/life processes"

Quality health care is the

"degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge"

Nursing informatics

"uses information and technology to communicate, manage knowledge, mitigate error, and support decision-making"

TBON 213.29 Fitness to Practice

(a) Each individual who seeks to practice nursing in Texas must possess current fitness to practice. This requirement includes all individuals seeking to obtain or retain a license or privilege to practice nursing in Texas and applies in all eligibility and disciplinary matters. Each individual has a duty to self-evaluate to ensure that he/she is fit to practice before providing nursing care.

Maslow's Hierarchy of Needs

(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization

Discharging a Client:

-Activity -Medications -Environment, equipment -Treatments -Health teaching -Outpatient referrals, follow up, emergencies -Diet -Support System

What is my job in client health?

-Assist the client to progress through the stages -Meet the needs of the client for the stage they are in -Accept the client as they are -Help the client gain insight into what is happening

Reimbursement Systems:

-Prospective Payment System (PPS) -Diagnosis-related groups (DRGs) -Managed care

Institute of Medicine Competencies for the Twenty-First Century

-Provide Patient-Centered Care -Work in Interdisciplinary Teams -Use Evidence-Based Practice -Apply Quality Improvement -Use Informatics

Challenges to Healthcare

-Uninsured patients -Reducing health care costs while maintaining high- quality care for patients -Improving access and coverage for more people -Encouraging healthy behaviors -Nursing Shortages

health promotion model

-defines health as a positive, dynamic state, not merely the absence of disease -describes the multidimensional nature of people as they interact within their environment to pursue health

Non-adherence and Nursing

-do not judge -find the cause or barrier to compliance -remain positive (express caring/concern) -re-educate: change approach, compromise with client, plan with client

Florence Nightingale

-established the first nursing philosophy based on health maintenance and restoration -the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentery. She volunteered during the Crimean War in 1853 and traveled the battlefield hospitals at night carrying her lamp; thus she was known as the "lady with the lamp."

What is an Advanced Practiced Registered Nurse (APRN)?

-the most independently functioning nurse - has an advanced education in pathophysiology, pharmacology, and physical assessment and certification and expertise in a specialized area of practice -clinical nurse specialist (CNS), certified nurse practitioner (CNP), certified nurse midwife (CNM), and certified RN anesthetist (CRNA) -function as clinicians, educators, case managers, consultants, and researchers within their area of practice to plan or improve the quality of nursing care for patients and families

ADPIE broken down

1. Assess: perform a nursing assessment. 2. Diagnose: make nursing diagnoses. 3. Plan: formulate and write outcome/goal statements and determine appropriate nursing interventions based on the client's reality and evidence (research). 4. Implement care. 5. Evaluate the outcomes and the nursing care that has been implemented. Make necessary revisions in care interventions as needed. The next section is an overview and practical application of the steps of the nursing process. The steps are listed in the usual order in which they are performed.

ANA Standards of Professional Performance

1. Assessment 2. Diagnosis 3. Outcomes Identification 4. Planning 5. Implementation 5a. Coordination of Care 5b. Health Teaching and Health Promotion 5c. Consultation 5d. Prescriptive Authority and Treatment 6. Evaluation

Healthy People 2020 Goals

1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. *****2. Achieve health equity, eliminate disparities, and improve the health of all groups.**** 3. Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages.

Ten Rules of Performance in a Redesigned Health Care System

1. Care is based on continuous healing relationships. 2. Care is individualized based on patient needs and values. 3. The patient is the source of control, participating in shared decision making. 4. Knowledge is shared, and information flows freely. 5. Decision making is evidence based, with care based on the best available scientific knowledge. 6. Safety is a system property and focused on reducing errors. 7. Transparency is necessary through sharing information with patients and families. 8. Patient needs are anticipated through planning. 9. Waste is continuously decreased. 10. Cooperation and communication among clinicians are priorities.

ANA Standards of Nursing Practice

1. Ethics 2. Education. 3. Evidence-Based Practice and Research 4. Quality of Practice 5. Communication 6. Leadership 7. Collaboration 8. Professional Practice Evaluation 9. Resources 10. Environmental Health

Benner's stages of nursing proficiency

1. Novice 2. Advanced Beginner 3. Competent 4. Proficient 5. Expert

Stages of Health Behavior Change

1. precontemplation 2. contemplation 3. preparation 4. action 5. maintenance stage

deliberate practice enhances

1.Student performance/achievement 2.The amount and depth of student thinking 3.Students' conscious focus on their learning 4.The development of reflective and responsible professionalism

Curriculum Era

1900s to the 1940s. During this period nursing education expanded beyond basic anatomy and physiology courses to include courses in the social sciences, pharmacology, and "nursing arts" that addressed nursing actions, skills, and procedures

Research Era

1950s, '60s, and '70s, during which nurses became increasingly involved in conducting studies and sharing their findings. However, the earliest research studies had a psycho-social, anthropological, or educational focus.

theory era

1980s and 1990s, significantly contributed to knowledge development, and the nursing metaparadigm was proposed by Fawcett. This era resulted in the publication of several nursing journals, the development of nursing conferences, and the offering of more doctoral programs in nursing

Define Competent

A nurse who has been in the same clinical position for 2 to 3 years. This nurse understands the organization and specific care required by the type of patients (e.g., surgical, oncology, or orthopedic patients). He or she is a competent practitioner who is able to anticipate nursing care and establish long-range goals. In this phase the nurse has usually had experience with all types of psychomotor skills required by this specific group of patients.

Define Advanced Beginner

A nurse who has had some level of experience with the situation. This experience may only be observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care.

Define Expert

A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem. This nurse is able to zero in on the problem and focus on multiple dimensions of the situation. He or she is skilled at identifying both patient-centered problems and problems related to the health care system or perhaps the needs of the novice nurse

Define Proficient

A nurse with more than 2 to 3 years of experience in the same clinical position. This nurse perceives a patient's clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. This nurse focuses on managing care as opposed to managing and performing skills.

Transformational Leadership

A vision for the future and the systems and resources to achieve the vision are created by nursing leaders.

Which national standards with the American Nurses Associate Code of Ethics does Communication relate back to?

ANA Provision 1 ANA Provision 2 ANA Provision 3

Which national standards with the American Nurses Associate Code of Ethics does Emotional Stability relate back to?

ANA Provision 1 ANA Provision 4 ANA Provision 5

Which national standards with the American Nurses Association Code of Ethics does Professional Behavior relate back to?

ANA Provision 1 Provision 2 Provision 3 Provision 4 Provision 5

Which national standards with the American Nurses Associate Code of Ethics does Critical Thinking relate back to?

ANA Provision 4

Which national standards with the American Nurses Associate Code of Ethics does Physical Ability relate back to?

ANA Provision 4 ANA Provision 5

Which national standards with the American Nurses Associate Code of Ethics does Sensory relate back to?

ANA Provision 4 ANA Provision 5

What are some examples of Necessary Activities for Sensory?

Ability to hear monitoring device alarm and other emergency signals. Ability to discern auscultatory sounds and cries for help. Ability to observe patient's condition and responses to treatments and recognize subtly physical changes. Ability to palpate in physical examinations and various therapeutic interventions. Recognize environmental odors.

_________________ means that you are responsible professionally and legally for the type and quality of nursing care provided

Accountability

Action

Actively engaged in strategies to change behavior; lasts up to 6 months

Discharge Planning

Activities directed toward identifying future proposed therapy and the need for additional resources before and after returning home.

health promotion

Activities such as routine exercise and good nutrition that help patients maintain or enhance their present level of health and reduce their risk of developing certain diseases.

active strategies of health promotion

Activities that depend on the patient's motivation to adopt a specific health program.

passive strategies of health promotion

Activities that involve the patient as the recipient of actions by health care professionals.

NLN Human Flourishing

Advocate for patients and families in ways that promote their self-determination, integrity, and ongoing growth as human beings.

lateral violence

Aggressive and destructive behavior or psychological harassment of nurses against each other.

TBON Rule 217.11 Standards Applicable to Professional Nurses

All registered nurses shall: know and conform to all rules and laws affecting professional nursing practice; provide for the safety of the client and others; know the reasons for and effects of drugs administered; accurately report and document client care; respect a client's right to privacy; obtain instruction and supervision as needed when performing tasks; maintain professional boundaries; not commit abuse, exploitation, or fraud; demonstrate knowledge, skill, judgment, and conscientiousness when performing client care; provide professional nursing care without discrimination; collaborate with the client, family, and members of the health care team to provide continuity of care; utilize the nursing process to provide patient centered care; delegate responsibility appropriately; and be responsible for one's own continuing competence and professional growth.

Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples? (Select all that apply.) 1. Caregiver 2. Autonomy and accountability 3. Patient advocate 4. Health promotion 5. Lobbyist

Answer 1, 2, 3, 4. Each of these roles or skills includes activities for the professional nurse. Each of these is used in direct care or are part of professionalism that guides nursing practice.

Health care reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform? 12 1. Moving from an acute illness to a health promotion, illness prevention model 2. Moving from an illness prevention to a health promotion model 3. Moving from an acute illness to a disease management model 4. Moving from a chronic care to an illness prevention model

Answer 1. Health care reform also affects how health care is delivered. There is greater emphasis on health promotion, disease prevention, and management of illness.

The nurse spends time with the patient and family reviewing the dressing change procedure for the patient's wound. The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role? 1. Educator 2. Advocate 3. Caregiver 4. Case manager

Answer 1. The nurse is demonstrating the role of educator. An educator explains concepts and facts about health, describes the reason for routine care activities, demonstrates procedures such as home-care activities, reinforces learning or patient behavior, and evaluates the patient's progress in learning through return demonstration.

Match the advanced practice nurse specialty with the statement about the role. 1. Clinical nurse specialist 2. Nurse anesthetist 3. Nurse practitioner 4. Nurse-midwife a. Provides independent care, including pregnancy and gynecological services b. Expert clinician in a specialized area of practice such as adult diabetes care c. Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients who are healthy or have chronic conditions d. Provides care and services under the supervision of an anesthesiologist

Answer 1b, 2d, 3c, 4a. The role statements describe the activities performed and the role of the advanced practice nurse specialty. Nurse midwives care for women who are pregnant or have women's health needs. Clinical nurse specialists typically see hospitalized patients with a specific type of illness or health problem. Nurse practitioners usually practice in a primary care setting and care for patients who are healthy or have minor acute or stable chronic conditions. Certified nurse anesthetists care for patients during the surgical experience and administer anesthesia during surgery.

Which of the following Internet resources can help consumers compare quality care measures? (Select all that apply.) 1. WebMD 2. Hospital Compare 3. Magnet Recognition Program 4. Hospital Consumer Assessment of Healthcare 5. The American Hospital Association's webpage.

Answer 2, 4. Both of these are Internet sites that collect patient data to document hospitals' quality of care and patient satisfaction. WebMD is an internet source that is disease/condition specific. The Magnet Recognition Program is a hospital-initiated recognition that assesses the quality of nursing care and patient safety.

A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with them. The nurse is acting as the patient's: 1. Educator. 2. Advocate. 3. Caregiver. 4. Case manager.

Answer 2. An advocate protects the patient's human and legal right to make choices about his or her care. An advocate may also provide additional information to help a patient decide whether or not to accept a treatment or find an interpreter to help family members communicate their concerns.

An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, listens to her lung and heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed? 1. Diagnosis 2. Evaluation 3. Assessment 4. Implementation

Answer 3. Assessment is the collection of comprehensive data pertinent to the patient's health and the situation.

Nurses in an acute care hospital are attending a unit-based education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education? 1. Continuing education 2. Graduate education 3. In-service education 4. Professional Registered Nurse Education

Answer 3. In-service education programs are instruction or training provided by a health care agency or institution. An in-service program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution.

A nurse meets with the registered dietitian and physical therapist to develop a plan of care that focuses on improving nutrition and mobility for a patient. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Informatics

Answer 3. This is an example of the competency of teamwork and collaboration. This competency focuses on the nurse functioning effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care

A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed? 1. Planning 2. Evaluation 3. Assessment 4. Implementation

Answer 4. Implementation is completing coordinating care and completing the prescribed plan of care.

The examination for registered nurse (RN) licensure is exactly the same in every state in the United States. This examination: 1. Guarantees safe nursing care for all patients. 2. Ensures standard nursing care for all patients. 3. Ensures that honest and ethical care is provided. 4. Provides a minimal standard of knowledge for an RN in practice.

Answer 4. RN candidates must pass the NCLEX-RN® to attain licensure. Regardless of educational preparation, the examination for RN licensure is exactly the same in every state in the United States.

The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career? 1. Clinical nurse specialist 2. Nurse administrator 3. Nurse educator 4. Nurse researcher

Answer 4. The nurse researcher investigates problems to improve nursing care and to further define and expand the scope of nursing practice. He or she often works in an academic setting, hospital, or independent professional or community service agency.

A critical care nurse is using a computerized decision support system to correctly position her ventilated patients to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Informatics

Answer 4. Using decision support systems is one example of using informatics and gaining competency in informatics.

You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient with terminal cancer. As part of the preparation you have your classmates read the Nursing Code of Ethics for Professional Registered Nurses. Your instructor asks the class why this document is important. Which of the following statements best describes this code? 1. Improves self-health care 2. Protects the patient's confidentiality 3. Ensures identical care to all patients 4. Defines the principles of right and wrong to provide patient care

Answer 4. When giving care, it is essential to provide a specified service according to standards of practice and to follow a code of ethics. The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. It serves as a guide for carrying out nursing responsibilities to provide quality nursing care and the ethical obligations of the profession.

12. How does knowledge of genomics affect patient treatment decisions?

Answer Genomics describes the study of all the genes in a person, as well as interactions of those genes with each other and with that person's environment. Genomic information allows health care providers to determine how genomic changes contribute to patient conditions and influence treatment decisions.

Nurses have developed theories in response to: (Select all that apply.) 1. Changes in health care. 2. Prior nursing theories. 3. Changes in nursing practice. 4. Research findings. 5. Government regulations. 6. Theories from other disciplines. 7. Physician opinions.

Answer: 1, 2, 3, 4, 6. Nursing theories often build on the works of prior theories from nursing and other disciplines. As nursing education has expanded, so has the practice of nursing in response to changes in society and health care. In addition, nursing research, which serves as the foundation for evidence-based practice, has increased.

Theory is essential to nursing practice because it: (Select all that apply.) 1. Contributes to nursing knowledge. 2. Predicts patient behaviors in situations. 3. Provides a means of assessing patient vital signs. 4. Guides nursing practice. 5. Formulates health care legislation. 6. Explains relationships between concepts.

Answer: 1, 2, 4, 6. A theory contains a set of concepts, definitions, and assumptions that explain a phenomenon. The theory explains how these elements are uniquely related in the phenomenon. These components provide a foundation of knowledge for nurses to direct and deliver caring nursing practices. A theory helps explain an event by defining ideas or concepts, explaining relationships between the concepts, and predicting outcomes of nursing care. A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care.

The nursing staff is developing a quality program. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators (NDNQI) that the nurses can use to measure patient safety and quality for the unit? (Select all that apply.) 1. Use of physical restraints 2. Pain assessment, intervention, and reassessment 3. Patient satisfaction with food preparation 4. Registered nurse (RN) education and certification 5. Number of outpatient surgical cases per year

Answer: 1, 2, 4. Physical restraint use, pain management, and RN education and certification are among the reportable nursing-sensitive indicators for NDNQI. The other options are not nursing sensitive-indicators.

Which of the following are examples of a nurse participating in primary care activities? (Select all that apply.) 1. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2. Assessing the nutritional status of older adults who come to the community center for lunch 3. Working with patients in a cardiac rehabilitation program 4. Providing home wound care to a patient 5. Teaching a class to parents at the local grade school about the importance of immunizations

Answer: 1, 2, 5. Primary care activities are focused on health promotion. Health promotion programs contribute to quality health care by helping patients acquire healthier lifestyles. Health promotion activities help keep people healthy through exercise, good nutrition, rest, and adopting positive health attitudes and practices.

Which of the following statements related to theory-based nursing practice are correct? (Select all that apply.) 1. Nursing theory differentiates nursing from other disciplines. 2. Nursing theories are standardized and do not change over time. 3. Integrating theory into practice promotes coordinated care delivery. 4. Nursing knowledge is generated by theory. 5. The theory of nursing process is used in planning patient care. 6. Evidence-based practice results from theory-testing research.

Answer: 1, 3, 4, 6. The overall goal of nursing knowledge is to explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines. Theory generates nursing knowledge for use in practice, thus supporting evidence-based practice. The integration of theory into practice leads to coordinated care delivery and therefore serves as the basis for nursing. Although the nursing process is central to nursing, it is not a theory. Nursing theories are not stagnant and continue to evolve over time.

Which of the following are characteristics of managed care systems? (Select all that apply.) 1. Provider receives a predetermined payment for each patient in the program. 2. Payment is based on a set fee for each service provided. 3. System includes a voluntary prescription drug program for an additional cost. 4. System tries to reduce costs while keeping patients healthy. 5. Focus of care is on prevention and early intervention.

Answer: 1, 4, 5. Managed care programs have administrative control over primary health care services for a defined patient population. The provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. In this case the managed care organization assumes financial risk in addition to providing patient care. The organization's focus of care shifts from individual illness care to prevention, early intervention, and outpatient care. If people stay healthy, the cost of medical care declines. Systems of managed care focus on containing or reducing costs, increasing patient satisfaction, and improving the health or functional status of the individual.

A male patient has been laid off from his construction job and has many unpaid bills. He is going through a divorce from his marriage of 15 years and has been seeing his pastor to help him through this difficult time. He does not have a primary health care provider because he has never really been sick and his parents never took him to a physician when he was a child. Which external variables influence the patient's health practices? (Select all that apply.) 1. Difficulty paying his bills 2. Seeing his pastor as a means of support 3. Age of patient (46 years) 4. Stress from the divorce and the loss of a job 5. Family practice of not routinely seeing a health care provider

Answer: 1, 5. External factors impacting health practices include family beliefs and economic impact. The way that patients' families use health care services generally affects their health practices. Their perceptions of the seriousness of diseases and their history of preventive care behaviors (or lack of them) influence how patients think about health. Economic variables may affect a patient's level of health by increasing the risk for disease and influencing how or at what point the patient enters the health care system.

Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system? 1. Patient safety 2. Evidence-based practice 3. Patient satisfaction 4. Maintenance of competency

Answer: 1. Nursing work groups or councils who had a commitment to patient safety were a positive characteristic of the patient safety climate on the nursing unit. Open communication and nurses involved in problem solving related to errors were other factors contributing to patient safety.

A nurse is presenting a program to workers in a factory covering safety topics, including the wearing of hearing protectors when workers are in the factory. Which level of prevention is the nurse practicing? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Quaternary prevention

Answer: 1. Primary prevention is aimed at health promotion and includes health education programs, immunizations, and physical and nutritional fitness activities. It can be provided to an individual and includes activities that focus on maintaining or improving the general health of individuals, families, and communities. It also includes specific protection such as hearing protection in occupational settings.

A nurse is using data collected from the unit to monitor the incidence of falls after the unit implemented a new fall protocol. The nurse is working in which area? 1. Quality improvement (QI) 2. Health care patient system 3. Nursing informatics 4. Computerized nursing network

Answer: 1. Quality data are the outcome of both quality improvement (QI) initiatives. QI is an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy. The QI program of an institution focuses on improvement of health care-related processes such as fall prevention.

A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an appropriate goal for restorative care? 1. Patient will be able to walk 200 feet without shortness of breath. 2. Wound will heal without signs of infection. 3. Patient will express concerns related to return to home. 4. Patient will identify strategies to improve sleep habits.

Answer: 1. Restorative interventions focus on returning patients to their previous level of function or to reach a new level of function limited by their illness or disability. The goal of restorative care is to help individuals regain maximal functional status and to enhance quality of life through promotion of independence.

When taking care of patients, a nurse routinely asks if they take any vitamins or herbal medications, encourages family members to bring in music that the patient likes to help the patient relax, and frequently prays with her patients if that is important to them. The nurse is practicing which model? 1. Holistic 2. Health belief 3. Transtheoretical 4. Health promotion

Answer: 1. The nurse is using a holistic model of care that takes a more holistic view of health by considering emotional and spiritual well-being and other dimensions of an individual to be important aspects of physical wellness. The holistic health model of nursing attempts to create conditions that promote optimal health. Nurses using the holistic nursing model recognize the natural healing abilities of the body and incorporate complementary and alternative interventions such as music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery because they are effective, economical, noninvasive, nonpharmacological complements to traditional medical care.

A nurse is conducting a home visit with an older-adult couple. While in the home the nurse weighs each individual and reviews the 3-day food diary with them. She also checks their blood pressure and encourages them to increase their fluids and activity levels to help with their voiced concern about constipation. The nurse is addressing which level of need according to Maslow? 1. Physiological 2. Safety and security 3. Love and belonging 4. Self-actualization

Answer: 1. The nurse's actions address the basic physiological needs of nutrition, fluids, elimination, and oxygen. According to Maslow, basic needs must be met before meeting higher level needs.

A nurse is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following theories? 1. Roy 2. Levine 3. Watson 4. Johnson

Answer: 1. When applying Roy's adaptation model, the nurse helps the patient cope with/adapting to changes in physiological, self-concept, role function, and interdependence domains.

Match the following description to the appropriate middle-range theory. 1. Benner's Skill Acquisition 2. AACN's Synergy Model 3. Mishel's Uncertainty in Illness 4. Kolcaba's Theory of Comfort a. The nurse strives to relieve patients' distress. b. The nurse progresses through five stages of expertise. c. The nurse helps the patient to process and find meaning related to his or her illness. d. Matching nurse competencies to patient needs can improve patient outcomes.

Answer: 1b, 2d, 3c, 4a.

Match the following types of theory with the appropriate description. 1. Middle-range theory 2. Shared theory 3. Grand theory 4. Practice theory a. Very abstract; attempts to describe nursing in a global context b. Specific to a particular situation; brings theory to the bedside c. Applies theory from other disciplines to nursing practice d. Addresses a specific phenomenon and reflects practice

Answer: 1d, 2c, 3a, 4b.

Match the following descriptions to the appropriate grand theorist. 1. King 2. Henderson 3. Orem 4. Neuman a. Based on the theory that focuses on wellness and preventionof disease b. Based on the belief that people who participate in self-care activities are more likely to improve their health outcomes c. Based on 14 activities, the belief that the nurse should assist patients with meeting needs until they are able to do so independently d. Based on the belief that nurses should work with patients to develop goals for care

Answer: 1d, 2c, 3b, 4a.

Which of the following are symptoms of secondary traumatic stress and burnout that commonly affect nurses? (Select all that apply.) 1. Regular participation in a book club 2. Lack of interest in exercise 3. Difficulty falling asleep 4. Lack of desire to go to work 5. Anxiety while working

Answer: 2, 3, 4, 5. Nurses are particularly susceptible to the development of secondary traumatic stress and burnout—the components of compassion fatigue. Symptoms include decline in health, emotional exhaustion, irritability, restlessness, impaired ability to focus and engage with patients, feelings of hopelessness, inability to take pleasure from activities, and anxiety.

The nurse assesses the following risk factors for coronary artery disease (CAD) in a female patient. Which factors are classified as genetic and physiological? (Select all that apply.) 1. Sedentary lifestyle 2. Mother died from CAD at age 48 3. History of hypertension 4. Eats diet high in sodium 5. Elevated cholesterol level

Answer: 2, 3, 5. Genetic and physiological risk factors include those related to heredity, genetic predisposition to an illness, or those that involve the physical functioning of the body. Certain physical conditions such as being pregnant or overweight place increased stress on physiological systems (e.g., the circulatory system), increasing susceptibility to illness in these areas. A person with a family history of diabetes mellitus is at risk for developing the disease later in life because of a hereditary and genetic predisposition to the disease.

Using Maslow's hierarchy of needs, identify the priority for a patient who is experiencing chest pain and difficulty breathing. 1. Self-actualization 2. Air, water, and nutrition 3. Safety 4. Esteem and self-esteem needs

Answer: 2. According to Maslow's theory, basic physiological needs are the patient's first priority, especially when a patient is severely dependent physically. In this example, the patient's need for adequate oxygenation (air) is the priority.

Which statement made by a nurse shows that the nurse is engaging in an activity to help cope with secondary traumatic stress and burnout? 1. "I don't need time for lunch since I am not very hungry." 2. "I am enjoying my quilting group that meets each week at my church." 3. "I am going to drop my gym membership because I don't have time to go." 4. "I don't know any of the other nurses who met today to discuss hospital-wide problems with nurse satisfaction."

Answer: 2. Nurses experience secondary traumatic stress and burnout. Personal strategies to help prevent or cope with secondary traumatic stress or burnout include healthy eating, making time for yourself to pursue personal interests, getting plenty of sleep, and regular exercise and relaxation.

As part of a faith community nursing program in her church, a nurse is developing a health promotion program on breast self-examination for the women's group. Which statement made by one of the participants is related to the individual's perception of susceptibility to an illness? 1. "I have a door hanging tag in my bathroom to remind me to do my breast self-examination monthly." 2. "Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer." 3. "Since I am only 25 years of age, the risk of breast cancer for me is very low." 4. "I participate every year in our local walk/run to raise money for breast cancer research."

Answer: 2. On the basis of health belief model, the statement indicates that the patient is concerned about developing breast cancer and feels that there is a risk or susceptibility based on recognition of a familial link for the disease. Once this link is recognized, the patient may perceive the personal risk.

A nurse is presenting information to a management class of nursing students on the topic of financial reimbursement for achievement of established, measurable patient outcomes. The nurse is presenting information to the class on which topic? 1. Prospective payment system 2. Pay for performance 3. Capitation payment system 4. Managed care systems

Answer: 2. Pay for performance programs and public reporting of hospital quality data are designed to promote quality, effective, and safe patient care by physicians and health care organizations. These programs are quality improvement strategies that reward excellence through financial incentives to motivate change to achieve measurable improvements.

Which of the following types of theory influence the "evidence" in current "evidence-based practice (EBP)"? 1. Grand theory 2. Middle-range theory 3. Practice theory 4. Shared theory

Answer: 2. The original grand theories served as springboards for the development of the more modern middle-range theories, which, through testing in research studies, provide the "evidence" for EBP and promotes the translation of research into practice.

A patient comes to the local health clinic and states: "I've noticed how many people are out walking in my neighborhood. Is walking good for you?" What is the best response to help the patient through the stages of change for exercise? 1. "Walking is OK. I really think running is better." 2. "Yes, walking is great exercise. Do you think you could go for a 5-minute walk next week?" 3. "Yes, I want you to begin walking. Walk for 30 minutes every day and start to eat more fruits and vegetables." 77 4. "They probably aren't walking fast enough or far enough. You need to spend at least 45 minutes if you are going to do any good."

Answer: 2. The patient's response indicates she is in the contemplative state, possibly intending to make a behavior change within the next 6 months. The nurse's statement reinforces the behavior and provides a specific goal for the patient to begin her walking plan.

A community center is presenting a nurse-led program on the Patient Protection and Affordable Care Act. Which statement made by a participant indicates a need for further teaching? 1. "My small company will now have to offer the 75 employees health insurance or pay a penalty." 2. "As long as my son is a full-time student in college, I will be able to keep him on my health insurance until he is 26 years old." 3. "I signed up for the state health insurance exchange before the designated deadline to make sure I had health insurance." 4. "Since I have now been diagnosed with diabetes, my health insurance plan cannot charge me higher premiums."

Answer: 2. This is an incorrect statement because with the Patient Protection and Affordable Care Act, dependents can remain on health plans until the age of 26 regardless of their status in school. They are not required to be full-time students to be eligible for the benefit. All other options are correct.

The nurse is caring for a patient admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. The nurse assumes responsibility for bathing and feeding the patient until the patient is able to begin performing these activities. The nurse in this situation is applying the theory developed by: 1. Neuman. 2. Orem. 3. Roy. 4. Peplau.

Answer: 2. When applying Orem's self-care deficit theory, the nurse continually assesses the patient's ability to perform self-care and intervenes as needed to ensure that physical, psychological, sociological, and developmental needs are being met. As the patient's condition improves, the nurse encourages the patient to begin doing these activities independently.

After a class on Pender's health promotion model, students make the following statements. Which statement does the faculty member need to clarify? 1. "The desired outcome of the model is health-promoting behavior." 2. "Perceived self-efficacy is not related to the model." 3. "The individual has unique characteristics and experiences that affect his or her actions." 4. "Patients need to commit to a plan of action before they adopt a health-promoting behavior."

Answer: 2. Within the model, perceived self-efficacy is one of the behavior-specific cognitions and affect. The behavior-specific cognitions have motivational significance within the model.

A nurse is using the Plan-Do-Study-Act (PDSA) strategy to do a quality improvement project to decrease patient falls on a nursing unit. Place the steps in the correct sequence for PDSA. 1. Bedside change of shift report is piloted on two medical-surgical units. 2. Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change. 3. The nursing council develops a strategy for bedside change of shift report. 4. After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units.

Answer: 3, 1, 2, 4. This sequences the step in the PDSA process.

Using the Transtheoretical Model of Change, order the steps that a patient goes through to make a lifestyle change related to physical activity. 1. The individual recognizes that he is out of shape when his daughter asks him to walk with her after school. 2. Eight months after beginning walking, the individual participates with his wife in a local 5K race. 3. The individual becomes angry when the physician tells him that he needs to increase his activity to lose 30 lbs. 4. The individual walks 2 to 3 miles, 5 nights a week, with his wife. 5. The individual visits the local running store to purchase walking shoes and obtain advice on a walking plan.

Answer: 3, 1, 5, 4, 2. This sequence follows the order of the steps of transtheoretical model of change: precontemplation, contemplation, preparation, action, and maintenance.

Which of the following nursing activities is provided in a secondary health care environment? 1. Conducting blood pressure screenings for older adults at the Senior Center 2. Teaching a clinic patient with chronic obstructive pulmonary disease purse-lipped breathing techniques 3. Changing the postoperative dressing for a patient on a medical-surgical unit 4. Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit

Answer: 3, 4. In secondary care the diagnosis and treatment of illnesses are traditionally the most commons services. Secondary services are usually provided in an acute care facility. Critical care units and inpatient medical-surgical units provide secondary and tertiary care.

A patient tells a nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO? 1. This health plan is for people who cannot afford their own health insurance. 2. This health plan is operated by the government to provide health care to older adults. 3. This health plan gives you a list of physicians and hospitals from which you can choose. 4. This is a fee-for-service plan in which you can choose any physician or hospital.

Answer: 3. PPO plans limit the enrollee's choice to a list of preferred providers such as hospitals and physicians. A participant pays more to using a provider not on the preferred list. PPO plans focus on health maintenance.

A nurse is preparing to begin intravenous fluid therapy for a patient. Which category of theory would be most helpful to the nurse at this time? 1. Grand theory 2. Middle-range theory 3. Practice theory 4. Shared theory

Answer: 3. Practice theories bring theory to the bedside. Narrow in scope and focus, these theories guide the nursing care of a specific patient population at a specific time.

Which activity shows a nurse engaged in primary prevention? 1. A home health care nurse visits a patient's home to change a wound dressing. 2. A nurse is assessing risk factors of a patient in the emergency department admitted with chest pain. 3. A school health nurse provides a program to the first-year students on healthy eating. 4. A nurse schedules a patient who had a myocardial infarction for cardiac rehabilitation sessions weekly.

Answer: 3. Primary prevention aimed at health promotion includes health education programs, immunizations, and physical and nutritional fitness activities. Primary prevention includes all

A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient 29correctly. A change is needed quickly. What type of quality improvement method would be most appropriate? 1. PDSA 2. Six Sigma 3. Rapid-improvement event (RIE) 4. A randomized controlled trial

Answer: 3. RIEs are very intense, usually week-long events, in which a group gets together to evaluate a problem with the intent of making radical changes to current processes. Changes are made within a very short time. The effects of the changes are measured quickly, results are evaluated, and further changes are made when necessary. An RIE is appropriate to use when a serious problem, such as the increased occurrence of medication errors, exists that greatly affects patient safety and needs to be solved quickly.

Which of the following categories of shared theories would be most appropriate for a patient who is grieving the loss of a spouse? 1. Biomedical 2. Leadership 3. Psychosocial 4. Developmental

Answer: 3. Rationale: You can use various psychosocial theories to help patients with loss, death, and grief.

While working in a rehabilitation facility, it is important to obtain nursing histories and develop a therapeutic nurse-patient relationship. List in correct order the phases of Peplau's theory as applied in this setting. The nurse: 1. Ensures that the patient has access to appropriate community resources for long-term care. 2. Collaborates with the patient to identify specific patient needs. 3. Collects essential information from the patient's health record. 4. Works with the patient to develop a plan for resolving patient issues.

Answer: 3. Rationale: You can use various psychosocial theories to help patients with loss, death, and grief.

A patient had surgery for a total knee replacement a week ago and is currently participating in daily physical rehabilitation sessions at the surgeon's office. In what level of prevention is the patient participating? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Quaternary prevention

Answer: 3. Tertiary prevention involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration following surgery. Tertiary prevention activities are directed at rehabilitation rather than diagnosis and treatment. Care at this level aims to help patients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairment. This level of care is called preventive care because it involves preventing further disability or reduced functioning.

A patient registered at the local fitness center and purchased a pair of exercise shoes. The patient is in what stage of behavioral change? 1. Precontemplation 2. Contemplation 3. Preparation 4. Action

Answer: 3. The individual is in the preparation stage, making small changes toward preparation for a change in the next month. In this stage the patient believes that the advantages outweigh the disadvantages.

Based on the transtheoretical model of change, what is the most appropriate response to a patient who states: "Me, stop smoking? I've been smoking since I was 16!" 1. "That's fine. Some people who smoke live a long life." 2. "OK. I want you to decrease the number of cigarettes you smoke by one each day, and I'll see you in 1 month." 3. "I understand. Can you think of the greatest reason why stopping smoking would be challenging for you?" 4. "I'd like you to attend a smoking cessation class this week and use nicotine replacement patches as directed."

Answer: 3. The patient's response indicates that he is in the precontemplation stage and not intending to make a change in behavior in the next 6 months. In this stage the patient is not interested in information about the behavior and may be defensive when confronted with the information. Asking an open-ended question about smoking may stimulate the patient to identify a reason to begin a behavior change. Nurses are challenged to motivate and facilitate health behavior change in working with individuals.

Which of the following statements is true regarding Magnet status recognition for a hospital? 1. Nursing is run by a Magnet manager who makes decisions for the nursing units. 2. Nurses in Magnet hospitals make all of the decisions on the clinical units. 3. Magnet is a term that is used to describe hospitals that are able to hire the nurses they need. 4. Magnet is a special designation for hospitals that achieve excellence in nursing practice.

Answer: 4. Magnet status is a process and review that hospitals go through that shows achievement of excellence in nursing practice. The designation is given by the American Nurses Credentialing Center and focuses on demonstration of quality patient care, nursing excellence, and innovations in professional practice.

Which activity performed by a nurse is related to maintaining competency in nursing practice? 1. Asking another nurse about how to change the settings on a medication pump 2. Regularly attending unit staff meetings 3. Participating as a member of the professional nursing council 4. Attending a review course in preparation for a certification examination

Answer: 4. Maintaining ongoing competency is a nurse's responsibility. Earn certification in a specialty area is one mechanism that demonstrates competency. Specialty certification has been shown to be positively related to patient safety.

A nurse ensures that each patient's room is clean; well ventilated; and free from clutter, excessive noise, and extremes in temperature. Which theorist's work is the nurse practicing in this example? 1. Henderson 2. Orem 3. King 4. Nightingale

Answer: 4. Nightingale's environmental theory directs the nurse to manipulate the environment to promote rest and healing.

The components of the nursing metaparadigm include: 1. Person, health, environment, and theory 2. Health, theory, concepts, and environment 3. Nurses, physicians, health, and patient needs

Answer: 4. Person, health, environment, and nursing are the four components that comprise the nursing metaparadigm.

The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the Plan-Do-Study-Act (PDSA) model. Which of the following is an example of "Do" from that model? 1. Implementing the new skin care protocol on all medicine units 2. Reviewing the data collected on patients cared for using the protocol 3. Reviewing the quality improvement reports on the six patients who developed ulcers over the last 3 months 4. Based on findings from patients who developed ulcers, implementing an evidence-based skin care protocol

Answer: 4. The PDSA cycle is a model for quality and performance improvement. The model is: Plan—review available data to understand existing practice conditions or problems to identify the need for change; Do—select an intervention on the basis of the data reviewed and implement the change; Study—study (evaluate) the results of the change; and Act—if the process change is successful with positive outcomes, act on the practices by incorporating them into daily unit performance.

ADPIE - Nursing Process

Assessment Diagnosis Planning Implementation Evaluation

The nursing process involves five dynamic and fluid phases. Within each of these phases, the client and family story is embedded and is used as a foundation for knowledge, judgment, and actions brought to the client care experience. A description of the "patient's story" and each aspect of the nursing process follow. The five phases are:

Assessment Diagnosis Planning Intervention Evaluation

What is the Sensory Standard?

Auditory ability sufficient for monitoring and assessing health needs. Must be able to hear without the aid of an interpreter. Visual ability sufficient for observation and assessment necessary in patient care. Tactile ability sufficient for physical assessment. Olfactory ability sufficient for observation and assessment necessary for safe client care.

______________ is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders

Autonomy

Define Novice

Beginning nursing student or any nurse entering a situation in which there is no previous level of experience (e.g., an experienced operating room nurse chooses to now practice in home health). The learner learns via a specific set of rules or procedures, which are usually stepwise and linear

Impact of Illness on the Patient and Family

Behavioral and emotional changes Impact on body image Impact on self-concept Impact on family roles Impact on family dynamics

What is the Communication Standard?

Communication abilities sufficient for verbal, written and electronic format.

Contemplation

Considering a change within the next 6 months

New Knowledge, Innovations, and Improvements

Contributions are made to the profession in the form of new models of care, use of existing knowledge, generation of new knowledge, and contributions to the science of nursing.

What are the Essential Requirements for participating in the nursing program?

Critical Thinking Professional Behavior Communication Physical Ability Sensory Emotional Stability

What is the Critical Thinking Standard?

Critical Thinking ability for effective clinical reasoning and clinical judgement consistent with level of educational preparation.

wellness

Dynamic state of health in which an individual progresses toward a higher level of functioning, achieving an optimum balance between internal and external environments.

What is the Emotional Stability Standard?

Emotional stability sufficient to tolerate rapidly changing conditions and environmental stress.

What are some examples of Necessary Activities for Emotional Stability?

Establish therapeutic interpersonal boundaries. Provide clients with emotional support. Adapt to changing environment and stress while maintaining professional conduct and standards without displaying hostility, agitation, rudeness, or belligerence. Poses no threat to self or others. Manage and respond to multiple priorities in stressful situations.

TBON Rule 213.37 Good Professional Character

Every individual who seeks licensure to practice professional nursing in Texas must have good professional character. The Board defines good professional character as the integrated pattern of personal, academic, and occupational behaviors which indicates that an individual is able to consistently conform his/her conduct to the requirements of the Nursing Practice Act, the Board's rules and regulations, and generally accepted standards of nursing practice. An individual must maintain good professional character to ensure that he/she is able to consistently act in the best interest of patients/clients and the public.

NLN Spirit of Inquiry

Examine the evidence that underlies clinical nursing practice to challenge the status quo, question underlying assumptions, and offer new insights to improve the quality of care for patients, families, and communities.

Spirit of Inquiry

Examine the evidence that underlies clinical nursing practice to challenge the status quo, question underlying assumptions, and offer new insights to improve the quality of care for patients, families, and communities.

____________ variables influencing a patient's illness behavior include the visibility of symptoms, social group, cultural background, economic variables, accessibility of the health care system, and social support

External

Medicare

Federally funded national health insurance program in the United States for people over 65 years of age. The program is administered in two parts. Part A provides basic protection against costs of medical, surgical, and psychiatric hospital care. Part B is a voluntary medical insurance program financed in part from federal funds and in part from premiums contributed by people enrolled in the program.

State Children's Health Insurance Program (SCHIP)

Federally funded, state-operated program to provide health coverage for uninsured children. Individual states determine participation eligibility and benefits.

Empirical Quality Outcomes

Focus is on structure and processes and demonstration of positive clinical, workforce, and patient and organizational outcomes.

professional standards review organization (PSRO)

Focuses on evaluation of nursing care provided in a health care setting. The quality, effectiveness, and appropriateness of nursing care for the patient are the focus of evaluation.

work redesign

Formal process used to analyze the work of a certain work group and change the actual structure of the jobs performed.

The ____________ prospective reimbursement system is based on payment calculated on the basis of DRG assignment.

Medicare

Teamwork and Collaboration

Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care. Examples: Recognize the contributions of other health team members and patient's family members. Discuss effective strategies for communicating and resolving conflict. Participate in designing methods to support effective teamwork.

________________, the increasing connectedness of the world's economy, culture, and technology, is one of the forces reshaping the health care delivery system

Globalization

diagnosis-related group (DRG)

Group of patients classified to establish a mechanism for health care reimbursement based on length of stay. Classification is based on the following variables: primary and secondary diagnosis, co-morbidities, primary and secondary procedures, and age.

illness prevention

Health education programs or activities directed toward protecting patients from threats or potential threats to health and minimizing risk factors.

______________ patients are acutely ill, requiring better coordination of services before discharge.

Hospitalized

Which standards with the National League for Nursing (NLN) Outcomes and Competencies for Graduates of Associate Degree Programs in Nursing relate back to Professional Behavior?

Human flourishing Professional Identity Nursing Judgement Spirit of Inquiry

Developmental theory

Humans have a common pattern of growth and development.

stress/adaptation theory

Humans respond to actual or perceived threats by adapting to maintain function and life.

What are some examples of Necessary Activities for Critical Thinking?

Identification of cause/effect relationships in clinical situations. Use of the nursing process in the development of patient care plans. Evaluation of the effectiveness of nursing interventions implemented. Solve problems and make valid rational decisions using logic, creativity, and reasoning. Respond instantly to emergency situations. Exhibit arithmetic competence that would allow the student to read, understand, and perform calculations for computing dosages.

NLN Professional Identity

Implement one's role as a nurse in ways that reflect integrity, responsibility, ethical practices, and an evolving identity as a nurse committed to evidence-based practice, caring, advocacy, and safe, quality care for diverse patients within a family and community context.

Professional Identity

Implement one's role as a nurse in ways that reflect integrity, responsibility, ethical practices, and an evolving identity as a nurse committed to evidence-based practice, caring, advocacy, and safe, quality care for diverse patients within a family and community context.

Diagnosis Phase

In this phase of the nursing process, the nurse begins clustering the information within the client story and formulates an evaluative judgment about a client's health status. Only after a thorough analysis—which includes recognizing cues, sorting through and organizing or clustering the information, and determining client strengths and unmet needs—can an appropriate diagnosis be made. This process of thinking is called clinical reasoning.

______________ costs and decreasing reimbursement are forcing health care institutions to deliver care more efficiently without sacrificing quality.

Increasing

NLN Nursing Judgement

Make judgements in practice, substantiated with evidence, that integrate nursing science in the provision of safe, quality care and promote the health of patients within a family and community context.

Nursing Judgement

Make judgements in practice, substantiated with evidence, that integrate nursing science in the provision of safe, quality care and promote the health of patients within a family and community context.

Preparation

Making small changes in preparation for a change in the next month

human needs theory

Need motivates human behavior. Maslow's hierarchy of basic human needs includes five levels of priority (e.g., physiological, safety and security, love and belonging, self-esteem, and self-actualization)

Precontemplation

Not intending to make changes within the next 6 months

Tanner's Clinical Judgement Model

Noticing Interpreting Responding Reflecting

The 5 Stages of Dr. Benner's Novice to Expert Theory

Novice Advanced Beginner Competent Proficient Expert

___________ are facing the challenge of keeping populations healthy and well within their own homes and communities.

Nurses

Block and Parish Nursing

Nurses living within a neighborhood provide services to older patients or those unable to leave their homes. It fills in gaps not available in traditional health care system.

nursing facility became the term for nursing homes and other facilities that provided long-term care. Now __________ __________ is the more appropriate term

Nursing Center

Which standards with the National League for Nursing (NLN) Outcomes and Competencies for Graduates of Associate Degree Programs in Nursing relate back to Critical Thinking?

Nursing Judgement Spirit of Inquiry

Gray

Nursing is not back or white. It is _________, which means it depends.

What is the Physical Ability Standard?

Physical abilities sufficient for movement from room to room and in small spaces. Gross and fine motor abilities sufficient for providing safe, effective nursing care.

utilization review (UR) committees

Physician-supervised committees to review admissions, diagnostic testing, and treatments provided by physicians or health care providers to patients.

writing the 3 part nursing diagnosis statement

Problem—Choose the label (nursing diagnosis) using the guidelines explained previously. A list of nursing diagnosis labels can be found in Section II and on the inside front cover. Etiology—Write an r/t phrase (etiology). These can be found in Section II. Symptoms—Write the defining characteristics (signs and symptoms), or the "as evidenced by" (aeb) list. A list of the signs and symptoms associated with each nursing diagnosis can be found in Section III.

Managed care organization (MCO)

Provides comprehensive preventive and treatment services to a specific group of voluntarily enrolled people. Structures include a variety of models.

A thorough analysis of ________ data leads clinicians to understand work processes and the need to change practice.

QI (Quality Improvement)

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. Examples: Involve family and friends in care. Elicit patient values and preferences. Provide care with respect for diversity of the human experience.

Respite care

Respite care is a service that provides short-term relief or "time off" for people providing home care to an individual who is ill, disabled, or frail

Reflecting

Reviewing your thinking and its effectiveness encourages deeper under-standing of your ability to think, supports self-evaluation, and, with honest reflection, fosters growth in your ability to use critical thinking and clinical judgment.

integrated delivery network (IDN)

Set of providers and services organized to deliver a coordinated continuum of care to the population of patients served at a capitated cost.

SMART outcomes breakdown

Specific Measurable Attainable Realistic Timed

Medicaid

State medical assistance to people with low incomes, based on Title XIX of the Social Security Act. States receive matching federal funds to provide medical care and services to people meeting categorical and income requirements.

Exemplary Professional Practice

Strong professional practice is established, and accomplishments of the practice are demonstrated.

Structural Empowerment

Structures and processes provide an innovative environment in which staff are developed and empowered and professional practice flourishes.

What is the Professional Behavior Standard?

Student Nurses are expected to respect the nursing profession to which they aspire and perform and behave in a respectful, ethical and professional manner with others in class, lab and clinical.

Noticing

The Noticing Step involves collecting data about the patient or a healthcare situation. The nurse uses assessment techniques such as observation and auscultation to collect data.

Responding

The conclusions you made based on interpretation of the data determine how you will respond to the situation. In other words, the determinations made in the Interpreting Step are important for deciding how and to what degree you will respond.

Evaluation Phase

The final phase of the nursing process is evaluation. Evaluation occurs not only at the end of the nursing process, but throughout the process. Evaluation of an intervention is, in essence, another nursing assessment; hence, the dynamic feature of the nursing process

Nightingale's Environmental Theory

The focus of Nightingale's grand theory is a patient's environment, which Nightingale believed nurses should manipulate (e.g., ventilation, light, decreased noise, hygiene, nutrition) so nature is able to restore a patient to health

Temple College ADN Mission

The mission of the ADN Program is to foster student success for professional licensure, lifelong learning, and entry level practice which provides quality, compassionate care within the ADN scope of practice to the diverse community we serve.

Ms. Thom, age 46, works as an RN in the intensive care unit at a large busy medical center. Over the last three years she has gained 30 lbs and quit attending the fitness classes at the local recreation center. Her co-workers keep trying to get her to come back to fitness class, but she says that she is too tired after work and just wants to go home. She has smoked for 15 years, but says that she is trying to cut back on the number of cigarettes each day because she watched her mother die from emphysema. She has picked up some literature from Employee Health on smoking cessation. She was recently diagnosed with hypertension. 1. Using the health belief model, identify the modifying factors impacting Ms. Thom's likelihood of taking a preventive health action.

The modifying factors influence the individual's perception of seriousness of the illness. Modifying factors include demographic and sociopsychological variables, perceived threat of the illness, and cues to action. For Ms. Thom, modifying factors include the demographic and sociopsychological variables of age and peer group influence, as her co-workers try to get her to exercise again. Ms. Thom's perceived threat of illness comes from the recent diagnosis of hypertension. Ms. Thom has two cues to action: her mother dying from emphysema and the media materials on smoking cessation she picked up from Employee Health.

ANA Provision 4

The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care.

self confidence

The nurse must have the _______ _____________ to be comfortable asking for help. Not noticing a problem or issue because the nurse may need help with the situation is an unacceptable behavior

ANA Provision 5

The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

ANA Provision 3

The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

ANA Provision 2

The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population.

ANA Provision 1

The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.

deliberate practice

The path to expert thinking requires many instances of _______________ ___________, breaking down all the elements of thinking that must be used to reach a sound decision. As you engage in ___________ ______________ you will constantly reflect on the thinking you used, identify what went right, identify any errors, correct the errors, then use what you learned for the next session.

Which primary intervention activities are important for Ms. Thom?

The primary prevention/intervention activities that are important for Ms. Thom are healthy diet and exercise, influenza vaccine, stress management, and health education on smoking cessation.

__________ generates nursing knowledge used in practice. Nurses use the nursing process to apply the theory or knowledge. The integration of theory and nursing process is the basis for professional nursing.

Theory

Psychosocial theory

Theory explains and/or predicts human responses within the physiological, psychological, sociocultural, developmental, and spiritual domains

Biomedical theory

Theory explains causes of disease; principles related to physiology.

Educational theory

Theory explains the teaching-learning process by examining behavioral, cognitive, and adult learning principles.

leadership/management theory

Theory promotes organization, change, power/empowerment, motivation, conflict management, and decision-making.

School Health

These are comprehensive programs that include health promotion principles throughout a school curriculum. They emphasize program management, interdisciplinary collaboration, and community health principles.

Community Health Centers

These are outpatient clinics that provide primary care to a specific patient population (e.g., well-baby, mental health, diabetes) that lives in a specific community. They are often associated with a hospital, medical school, church, or other community organization.

Nurse-Managed Clinics

These clinics provide nursing services with a focus on health promotion and education, chronic disease assessment management, and support for self-care and caregivers.

Physicians' Offices

They provide primary health care (diagnosis and treatment). Many focus on health promotion practices. Nurse practitioners often partner with a physician in managing a patient population (e.g., diabetes, arthritis).

Occupational Health

This is a comprehensive program designed for health promotion and accident or illness prevention in the workplace setting. It aims to increase worker productivity, decrease absenteeism, and reduce use of expensive medical care

Assessment Phase

This phase of the nursing process is foundational for appropriate diagnosis, planning, and intervention. Data on all dimensions of the "patient's story," including biophysical, psychological, sociocultural, spiritual, and environmental characteristics, are embedded in the assessment, which involves performing a thorough holistic nursing assessment of the client. This is the first step needed to make an appropriate nursing diagnosis, and it is done using the assessment format adopted by the facility or educational institution in which the practice is situated.

Private insurance

Traditional fee-for-service plan. Payment is computed after patient receives services on basis of number of services used.

Preferred provider organization (PPO)

Type of managed care plan that limits an enrollee's choice to a list of "preferred" hospitals, physicians, and providers. An enrollee pays more out-of-pocket expenses for using a provider not on the list.

Dorothea Orem Orem's Self-Care Deficit Nursing Theory

When applying this grand theory, a nurse continually assesses a patient's ability to perform self-care and intervenes as needed to ensure that the patients meets physical, psychological, 48sociological, and developmental needs.

What are some examples of Necessary Activities for Communication?

Write and speak English effectively in order to be understood by the general public. Communicate therapeutically with clients, families, and groups in a variety of settings. Communicate appropriately with faculty and peers. Documentation and interpretation of nursing actions and patient/client responses. Provide health teaching information for clients, families, and/or groups based on assessed needs, available resources, age, lifestyle, and cultural considerations. Remember pertinent information and communicate to all interdisciplinary team members, client and family where consented.

An ICU or critical care unit is

a hospital unit in which patients receive close monitoring and intensive medical care

Discharge planning begins the moment...

a patient is admitted to a health care facility

paradigm

a pattern of beliefs used to describe the domain of a discipline. It links the concepts, theories, beliefs, values, and assumptions accepted and applied by the discipline

Internal variables include

a person's developmental stage, intellectual background, perception of functioning, and emotional and spiritual factors.

The transtheoretical model of change describes

a series of changes through which patients progress for successful behavior change rather than simply assuming that all patients are in an action stage.

Illness

a state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired

hospice

a system of family-centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness.

The "patients story"

a term used to describe objective and subjective information about the client that describes who the client is as a person in addition to their usual medical history

Mrs. Langman is in the hospital recovering from hip replacement surgery. Her surgery involved insertion of a new type of hip replacement prosthesis and newer postsurgical care. The advanced practice registered nurse (APRN) is preparing her discharge medication and rehabilitation prescriptions. The staff nurse is preparing to transfer Mrs. Langman to a rehabilitation facility. The nurse educator is conducting bedside rounds to explain the new prosthesis and related postoperative care. a. Discuss the roles of the staff nurse, APRN, and nurse educator. b. What is the educational preparation for each role?

a. A staff nurse provides direct care for a group of patients in a health care setting. This practice is guided by the standards of professional practice and the agencies practice philosophy. An advanced practice registered nurse is the most independently functioning nurse. He or she has a master's degree in nursing; advanced education in pathophysiology, pharmacology, and physical assessment; and certification and expertise in a specialized area of practice. A nurse educator works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments. Nurse educators need experience in clinical practice to provide them with practical skills and theoretical knowledge. A faculty member in a school of nursing educates students to become professional nurses. Nursing faculty members are responsible for teaching current nursing practice, trends, theory, and necessary skills in laboratories and clinical settings. b. Staff nurses have basic education and NCLEX licensure. Advanced practice registered nurses have master's degree preparation and advance practice certification. Nurse educators have a master's or doctoral degree in nursing.

Grand theories

abstract, broad in scope, and complex; therefore they require further clarification through research so they can be applied to nursing practice.

prescriptive theories

address nursing interventions for a phenomenon, guide practice change, and predict the consequences

health belief model

addresses the relationship between a person's beliefs and behaviors. The health belief model helps you understand factors influencing patients' perceptions, beliefs, and behavior to plan care that will most effectively help patients maintain or restore health and prevent illness.

As a patient _____________ you protect your patient's human and legal rights and provide assistance in asserting these rights if the need arises

advocate

nursing metaparadigm

allows nurses to understand and explain what nursing is, what nursing does, and why nurses do what they do

practice theories

also known as situation-specific theories, bring theory to the bedside. Narrow in scope and focus, these theories guide the nursing care of a specific patient population at a specific time

What is a Certified Nurse Midwife (CNM)?

an APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwives

What is a Clinical Nurse Specialist (CNS)?

an APRN who is an expert clinician in a specialized area of practice

What is a Nurse Practitioner (NP)?

an APRN who provides health care to a group of patients, usually in an outpatient, ambulatory care, or community-based setting

What is a Certified Registered Nurse Anesthetist (CRNA)?

an APRN with advanced education from a nurse anesthesia-accredited program

holistic health model

attempts to create conditions that promote a patient's optimal level of health. In this model nurses using the nursing process consider patients to be the ultimate experts concerning their own health and respect patients' subjective experience as relevant in maintaining health or assisting in healing.

Successful community-based health programs involve

building relationships with the community and incorporating cultural and environmental factors.

Nursing definitions reflect

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

As a _____________ you help patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process

caregiver

Changes in society such as increased technology, new demographic patterns, consumerism, health promotion, and the women's and human rights movements lead to

changes in nursing

Before nurses can apply clinical judgment/ clinical reasoning to patient care and healthcare situations they must first develop

clinical judgment/clinical reasoning

The missing piece is teaching students the actual thinking process so they can develop

clinical judgment/clinical reasoning

Your effectiveness as a _______________ is central to the nurse-patient relationship. It allows you to know your patients, including their strengths, weaknesses, and need

communicator

To be able to provide competent, quality and safe care, nurses need to take care of themselves to ensure they remain healthy. Nurses are particularly susceptible to the development of ________________ _________, which is a combination of secondary traumatic stress (STS) and burnout (BO)

compassion fatigue

Using personal and professional strategies that focus on caring for self can help to decrease or prevent

compassion fatigue.

Think of ___________ as ideas and mental images

concepts

With deliberate practice, you will demonstrate

connections among many pieces of information and discover solutions to problems by applying critical thinking abilities to nursing.

The two part nursing diagnosis

consists of the nursing diagnosis and the "related to" (r/t) statement: "Related factors are etiologies, circumstances, facts, or influences that have some type of relationship with the nursing diagnosis (e.g., cause, contributed factor)."

The three part Nursing Diagnosis

consists of the nursing diagnosis, the r/t statement, and the defining characteristics, which are "observable cues/inferences that cluster as manifestations of an actual or wellness nursing diagnosis"

Defining Characteristics Phase

consists of the signs and symptoms that have been gathered during the assessment phase. The phrase "as evidenced by" (aeb) may be used to connect the etiology (r/t) with the defining characteristics. The use of identifying defining characteristics is similar to the process that the health care provider uses when making a medical diagnosis

managed care

describes health care systems in which a provider or health care system receives a predetermined capitated payment for each patient enrolled in the program

students must ___________ thinking skills before they can use thinking skills

develop

___________ planning begins at admission to a health care facility and helps in the transition of a patient's care from one environment to another.

discharge

Health and wellness are not merely the absence of

disease and illness

Input for the nursing process is the

data or information that comes from a patient's assessment

non adherent is

declining to follow medical advice

contextual

deliberate practice with _______________ thinking

The type of critical thinking used by the nurse is

deliberate, skillful, responsible, and thoughtful

Continuing Care

describes a variety of health, personal, and social services provided over a prolonged period

Leininger's Culture Care Theory

focus on culture in nursing as she predicted that nursing and health care would become more global. She blended her background in anthropology with nursing to form her middle-range theory of cultural care diversity and universality

Primary Health Care

focuses on improved health outcomes for an entire population

Secondary prevention

focuses on individuals who are experiencing health problems or illnesses and are at risk for developing complications or worsening conditions

adherence

following of recommended medical advice

__________ theories provide complex structural frameworks for broad, abstract ideas.

grand

Health

has different meanings for each patient, the clinical setting, and the health care profession (see Chapter 6). It is a state of being that people define in relation to their own values, personality, and lifestyle

The World Health Organization (WHO) defines ________ as a "state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity"

health

Levels of health care describe the range of services and settings in which health care is available to patients in all stages of _________ and _________

health and illness

Understanding the process of changing behaviors will help you support difficult _______ _____________ changes in patients. It is believed that change involves movement through a series of stages

health behavior

Currently in the United States the most frequent way to become a ___________ _________ is through completion of either an associate or baccalaureate degree program

registered nurse

The goal of __________________ is to allow individuals to return to a level of normal or near-normal function after a physical or mental illness, injury, or chemical dependency.

rehabilitation

Multiple models of health in which persons are active participants explain

relationships among health beliefs, health behaviors, health promotion, and individual well-being.

Theory-testing

research determines how accurately a theory describes nursing phenomena.

Theory-generating

research discovers and describes relationships without imposing preconceived notions (e.g., hypotheses) of what the phenomenon under study means.

The goals of _________________ care are to help individuals regain maximal functional status and enhance quality of life through promotion of independence and self-care

restorative

Rehabilitation

restores a person to the fullest physical, mental, social, vocational, and economic potential possible

Factors used to evaluate Good Professional Character for TBON Rule 213.27 include:

whether the individual is able to distinguish right from wrong; whether the individual is able to think and act rationally; whether the individual is able to keep promises and honor obligations; whether the individual is accountable for his/her own behavior and/or accepts responsibility for his/her actions; whether the individual is able to recognize and honor the interpersonal boundaries appropriate to any therapeutic relationship or health care setting; whether the individual is able to make appropriate judgments and decisions that could affect patients/clients and/or the public; any other behaviors bearing on the individual's honesty, accountability, trustworthiness, reliability, or integrity.

The PPACA focused on the major goals:

• All individuals are required to have some form of health insurance by 2014 or pay a penalty through the tax code. • Public program eligibility, including state Medicaid and Children's Health Insurance, is expanded. Primary care physician payments for Medicaid services increased to equal Medicare payments. • States will create health insurance exchanges whereby individuals and small business owners can purchase more affordable health insurance. The exchanges will also provide individuals and small employers with consumer information to aid them in making decisions regarding alternative health insurance policies. • Insurance regulations that prevent private insurance companies from denying insurance coverage for any reason and from charging higher premiums based on health status and gender will be implemented. • A financial penalty will be assessed to employers of more than 50 employees if they do not offer health insurance coverage to employees. • Adult children up to the age of 26, regardless of student status, are allowed to be covered under their parents' health insurance plan.

Continuing Care

• Assisted living • Psychiatric and older adult day care

Culture Implications for Patient-Centered Care

• Be aware of the effect of culture on a patient's view and understanding of illness. • Understand a patient's traditions, values, and beliefs and how these dimensions may affect health, wellness, and illness. • Do not stereotype patients based on their culture and do not assume that they will adopt all cultural beliefs and practices • When teaching patients about their illness and treatment regimens, you need to understand that unique cultural perceptions exist regarding the cause of an illness and its treatment. • Use a trained interpreter if possible when a patient and family do not speak English to avoid misinterpretation of information • Be aware of your own cultural background and recognize prejudices that lead to stereotyping and discrimination

Preventive Care

• Blood pressure and cancer screenings • Immunizations • Mental health counseling and crisis prevention • Community legislation (e.g., seat belts, air bags, bike helmets, no texting while driving)

Restorative Care

• Cardiovascular and pulmonary rehabilitation • Orthopedic rehabilitation • Sports medicine • Spinal cord injury programs • Home care

Secondary Acute Care

• Emergency care • Acute medical-surgical care • Radiological procedures for acute problems (e.g., x-rays, computed tomography [CT] scans)

Goals of Theoretical Nursing Models

• Identify domain and goals of nursing. • Provide knowledge to improve nursing administration, practice, education, and research. • Guide research to expand the knowledge base of nursing. • Identify research techniques and tools used to validate nursing interventions. • Develop curriculum plans for nursing education. • Establish criteria for measuring quality of nursing care, education, and research. • Guide development of a nursing care delivery system. • Provide systematic structure and rationale for nursing activities.

Tertiary Care

• Intensive care • Subacute care

Nursing Quality Indicators

• Patient falls/falls with injuries • Falls in ambulatory settings • Pressure ulcers—hospital acquired, unit acquired • Pressure ulcer incidence rates from electronic health record (EHR) • Skill mix (registered nurse [RN], licensed practical nurse [LPN], unlicensed assistive personnel [UAP])—hospital units, emergency department (ED), perioperative and perinatal units • Nursing hours per patient day • Nursing care hours in ED, perioperative and perinatal units • RN surveys on job satisfaction and practice environment scale • RN education and certification • Pain assessment intervention/reassessment cycle • Hospital readmission rates • Physical/sexual assault • Physical restraints • Nurse turnover • Hospital-acquired infections of ventilator-associated pneumonia and events, central line-associated bloodstream infection, catheter-associated urinary tract infection

Primary Care (Health Promotion)

• Prenatal and well-baby care • Nutrition counseling • Family planning • Exercise, yoga, and mediation classes

Focus on Older Adults Health Promotion

• Promote healthy lifestyles by encouraging regular physical activity tailored to the individual's ability, accepting responsibility for one's own health, using stress-management strategies, focusing on self-care abilities, improving self-efficacy, and practicing relaxation exercises • Consider an older adult's social environment and strengthen social support to promote health and provide access to resources • Injury prevention is a key strategy to promote and improve health • Promote community-based exercise programs to decrease social isolation and increase independence • Factors that have been reported to affect older adults' willingness to engage in health promotion activities may include socioeconomic factors, beliefs and attitudes of patients and providers, encouragement by a health care professional, specific motivation based on efficacy beliefs, access to resources, age, number of chronic illnesses, mental and physical health, marital status, ability for self-care, gender, education, and support system presence • Encourage frequent healthy meals that are well balanced and contain fruits, vegetables, and dairy

Major Regulatory Requirements Defined by the 1987 Omnibus Budget Reconciliation Act

• Resident rights • Admission, transfer, and discharge rights • Resident behavior and facility practices • Quality of life • Resident assessment • Quality of care • Nursing services • Dietary services • Physician services • Specialized rehabilitative services • Dental services • Pharmacy services • Infection control • Physical environment • Administration

The National Priorities Partnership goals

• Work with communities to promote wide use of best practices to enable healthy living and well-being. • Promote the most effective prevention, treatment, and intervention practices for the leading causes of mortality, starting with cardiovascular disease. • Ensure person- and family-centered care. • Make care safer. • Promote effective communication and care coordination. • Make quality care affordable for people, families, employers, and governments. • Practicing to the full extent of their education and training. • Achieving higher levels of education and training through an improved education system that provides seamless progression. • Becoming full partners with physicians and other health care providers in redesigning the health care system. • Improving data collection and information infrastructure for effective workforce planning and policy making.

The three components of the Caputi Model for Teaching thinking in Nursing are

•Dr. Benner's Novice to Expert Teory (Benner, 2001) •Dr. Tanner's Clinical Judgment Model (Tanner, 2006) •Specific critical thinking skills and strategies

Dr. Tanner's Clinical Judgement Model

•Noticing •Interpreting •Responding •Reflecting