Nursing 2371 Exam 1 (Ch. 3 & 11)

WHO (2010) statement on professionalism

"It is no longer enough for health workers to be professional. They also need to be interprofessional."

Knowing the limitations of your expertise is an important aspect of clinical judgment

- Know when approaching the limits of expertise and consult additional professionals as needed - Nursing practice act, health agency policies, school of nursing policies, and profession's standards of practice all provide guidance in making decision about nursing actions within your scope of practice

Dynamic Nature of the Nursing Process

- Nurses are continuously moving from one phase to another and then beginning the process again. - Often a nurse performs two or more phases at the same time

Documents that Guide All Nurses in Their Professional Commitment

- Nursing's Social Policy Statement: The Essence of the Profession - A Contract with Society - Nursing: Scope and Standards of Practice - Code of Ethics for Nurses

Novice Thinking

- Organize knowledge as separate facts - Rely heavily on resources - Lack knowledge gained from actually doing - Focus on actions and may not fully assess before acting - Need and follow clear-cut rules

Professional Commitment

- Personal identification is derived from the profession. - Profession as a "calling" - Commitment transcends expectation of material reward

Historical influences

- Religious and military background and obedience - Florence Nightingale - Isabelle Hampton Robb

Writing a Plan of Care

- Standardized plan of care are based on common and recurring problems. - Critical pathways - multidisciplinary plans of care - Facilitates communication among all members of the health care team

Expert Thinking

- Store knowledge in highly organized and structured manner - Assess and consider different options for intervening before acting - Know which rules are flexible and when it is appropriate to bend the rules - Are aware of resources and how to use them

External conflicts

- Tension between medicine and nursing - Lobby for protection of nursing practice

Professional Preparation

- Typically in a college or university; requires instruction in the specialized body of knowledge and techniques - includes orientation to the beliefs, values, and attitudes; standards of practice and ethical considerations (socialization) - Intense preparation enables practitioners to act in a logical, rational manner using scientific knowledge and prescribed ways of thinking through problems

Flexner published a list of criteria that he believed to be characteristic of a profession:

- is basically intellectual (as opposed to physical) and is accompanied by a high degree of individual responsibility - is based on a body of knowledge that can be learned and is developed and refined through research - is practical, in addition to being theoretical

Collegial Behaviors

- share knowledge with colleges and students - take part in professional organizations - mentor less experienced nurses

Implementation

- when nursing orders are actually carried out - As the nurse carries out planned interventions, they are continually assessing the patient, noting responses to interventions, and modifying the care plan - need to be documented

What are some other SNL?

-Clinical Care Classification -Nursing Interventions Classification -Nursing Outcomes Classifications -Peri-operative Nursing Data Set -Omaha System-Community Health Classifications

What is the power of the board?

-approve schools of nursing -establish standards for nursing practice -examine, approve, renew and reinstate licenses -establish procedures for disciplinary process -maintain records of all Board proceedings

Profession

-education takes place in a college or university -education is prolonged -work involves mental creativity -decision making is based largely on science or theoretical constructs -values, beliefs, and ethics are integral part of preparation -accountability rest with individual

What are the 3 purposes of ANA?

-foster high standards of nursing -work for the improvement of health standards and availability of health care services of all people -stimulate and promote the professional development of nurses and advance their economic general welfare

What are some methods collecting data?

-interview -physical examinations -consultation

occupation

-material reward is main motivation -accountability rest primarily with employer -training may occurs on the job -work is largely manual -decision making is guided largely by experience -values, beliefs, and ethics are not prominent features of preparation

What 4 domains of factors that affect nurses' accurate documentation of diagnoses according to Paans?

-nurses themselves as effective diagnosticians -how nurses are educated about nursing diagnoses -complexity of a patient's situation -degree to which a hospital's policy and environment supports the use of nursing diagnosis

What was the Powers of the Board?

-publish an annual report -maintain a roster of licenses -adopt rules and regulations enforcing NPA -appoint an attorney -employ an executive director -obtain criminal record of applicants -regulate student nurses

Kelly's Criteria: 8 Characteristics of a Profession

-services provided are vital to humanity and the welfare of society -there is a special body of knowledge that is continually enlarged through research -service involves intellectual activities -practitioners are educated in institutions of higher learning -practitioners are relatively independent and control their own policies and activities -practitioners are motivated by service and consider their work an important component of their lives -code of ethics to guide the decisions and conduct of practitioners -there is an organization that encourages and support high standards of practice

What was Halls 5 attributes to a professional model?

-uses profession organization as primary point of reference -belief i n value of public service -belief in self regulation -commitment to a profession that goes beyond economic incentives -sense of autonomy in practice

4 domains of Interprofessional Collaborative practice Competency

-values/ethics for interprofessional practice -roles/responsibilities -interprofessional communication -teams and teamwork

The Process of Professionalism (professionalization)

1. Practitioners performed full-time work in the discipline. 2. They determined work standards, identified a body of knowledge, and established educational programs in institutions of higher learning. 3. They promoted organization into effective occupational associations, and then worked to establish legal protection that limited practice of their unique skills by outsiders. 4. Finally, they established codes of ethics.

Purpose of Code of Ethics for Nurses:

1. Succinct statement of ethical obligations & duties of every individual who enters the nursing profession. 2. The profession's non-negotiable ethical standard. 3. Expression of nursing's own understanding of its commitment to society.

Clinical Judgment: Nine Key Questions

1. What major outcomes (observable beneficial results) do we expect to see in this particular patient, family, or group when the plan of care is terminated? 2. What problems or issues must be addressed to achieve the major outcomes? 3. What are the circumstances? Who is involved? How urgent are the problems? What are the factors influencing their presentation? What are the patient's values, beliefs, and cultural influences? 4. What knowledge is required? 5. How much room is there for error? 6. How much time do I have? 7. What resources can help me? 8. Whose perspectives must be considered? 9. What is influencing my thinking?

What are the 3 characteristics Houle identified that occupation moves along a professional status?

1. defining group's mission and foundations of practice 2. mastery of theoretical knowledge, development of the capacity to solve problems, use of practical knowledge, and self-enhancement 3. development of a collective identity

Nursing's Social Policy Statement: The Essence of the Profession

A contract with society-framework for understanding professional nurses relationship with society

Steps of the Nursing Process

Assessment Diagnosis Planning Implementation Evaluation

beneficence

Doing good or causing good to be done; kindly action

What report called for medical schools to implement high standards for admission and graduation?

Flexner Report

Internal conflicts

Fragmented power and influence in professional nursing

Who identified characteristics that indicate that an occupation moves along the continuum toward professional status?

Houle

psychomotor domain

Involves physical movement and increasingly complex activities in the motor-skill arena. Learning in this domain can be assessed by measures such as distance, time, and speed.

LSBN Purpose

LSBN is an agency of the state charged with the responsibility to protect the public healthy, safety and welfare of the citizens of LA by regulating the practice of nursing by RN and advanced practiced RN

standardized nursing language (SNL)

Language readily understood by all nurses to describe care in order to provide a common means of communication.

Varying levels of education for entry into practice

Nursing's lack of a standardized requirement for a minimum of a BSN, and preferably a master's degree, stands in sharp contrast with other health care professions requiring more education to practice (David, 2000).

Nursing: Scope and Standards of Practice

Outlines the expectations of the professional role within which all RNs must practice and delineates the standards of care and associated competencies for professional nursing

How do you write a nursing diagnosis?

P-problem E-etiology S-signs/symptoms

What task force found that members of a profession share 10 characteristics?

Pharmacy Profession Task Force

Planning

The nurse develops a plan of care that prescribes interventions to attain expected outcomes

Gender issues

The persistent devaluing of women's work in our society has created an ongoing struggle for the nursing profession to increase the status, increase the compensation, and improve the working conditions

True/False Every goal has specific intervention, which may be carried out by a RN or delegated to other members of the nursing staff

True

True/False Nursing process is dynamic

True

nursing diagnosis

a clinical judgment about individual, family or community responses to actual or potential health problems or life processes; identifies the problems the patient is experiencing as a result of the disease process

nursing process

a conceptual framework that enables the student or the practicing nurse to think systematically and process pertinent information about the patient; combines "art of nursing" (creativity) with systems theory and the scientific method to produce high level care for your patients that is both interpersonal and interactive

inter-professionality

a process by which professionals reflect on and develop ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population

Roy Bixler and Genevieve Bixler

advocates and supporters of nursing even though they were not nurses themselves

ANA Position Paper

all nursing education should take place in institutions of higher education

reflective thinking

an active process valuable in learning and changing behaviors, perspectives, or practices

collective identity

collection of similarities that a group feels with one another

clinical judgement

consists of informed opinions and decisions based on empirical knowledge and experience

autonomy

control over one's practice

caring

core of professional nursing through which nurses intervene for their patients

Nurses who think _____________ are engaged in a process of constant evaluation, redirection, improvement, and increased efficiency.

critically

cultural congruent intervention

developed within the broad social, cultural, and demographic context of the patient's life

Cultural congruent intervention

developed within the broad social, cultural, and demographic context of the patient's life.

fidelity

faithfulness; loyalty

accountability

firmly rooted in the ethical principles of fidelity, loyalty, veracity, beneficence, and respect for the dignity, and self-determination of patients

Nightingale Pledge

first code of ethics; established roots for current code

University of Minnesota

first university-based nursing

Assessment

gather information or data about the individual, family, or community

altruism

ideal of service to others

independent interventions

innervation that requires no supervision or direction by others

cognitive domian

involved knowledge and intellectual skills; can range from simple recall to complex tasks

Affective Domain

involves the emotions

Strong professional identity makes it

less common to change careers than an occupation.

Outcome criteria define the terms under which the goal is said to be

met, partially met, or unmet

Goals should be agreed on by both

nurse and patient

What are the three things that make up the foundation of nursing?

person health environment

Maslow's Hierarchy of Needs

physiological, safety, love/belonging, esteem, self-actualization

Socio-cultural factors must be considered in

planning care

American Nurses Association (ANA)

primary advocate for nursing interests

Essence of Collegiality

promotion of a supportive and healthy work environment, cooperation, and recognition of interdependence among members of the nursing profession

Dependent interventions

require instructions, written prescriptions, or supervision of another health professional with prescriptive authority

goal

sets a general direction, includes an action verb, and should be both attainable and realistic for patient

What types of data is subjective and objective?

symptoms (subjective) objective (signs)

collegiality

the promotion of a supportive and healthy work environment, cooperation, and recognition of interdependence among members of the nursing profession

North American Nursing Diagnosis Association (NANDA) mission:

to facilitate the development, refinement, dissemination, and use of standard nursing diagnostic terminology with the goal to improve health care of all people

Code of Ethics for Nurses

tool that guides a group towards professional definition and provides evidence of professional legitimacy

veracity

truthfulness, honesty

Interdependent interventions

when a nurse has to collaborate with other health professionals before you can carry out the actions

Characteristics of a profession

•Can be taught through a process of highly specialized professional education •Has strong internal organization of members and a well-developed group consciousness