Ch 1: Nursing Today

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

1. Caregiver 2. Autonomy and Accountability 3. Patient advocate 4. Health Promotion 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.

Profession defined

1. Extended education 2. Theoretical body of knowledge 3. Specific service provided 4. Autonomy in decision making and practice 5. Code of ethic

Nursing Practice

-Nurse Practice Acts overseen by state board of nursing -Must pass the NCLEX-RN for licensure -May choose to certify in a specific area of nursing practice

Professional Nursing Education

-Associate degree or baccalaureate degree -Graduate/Post graduate education (masters, doctoral) -Continuing and in-service education

The nurse in the twenty-first century is facing an extremely complex profession with multiple external forces affecting the nursing profession. Factors influencing the nursing profession include which of the following? (Select all that apply.) a. Demography b. Women's health care c. Human rights d. The threat of bioterrorism e. The medically underserved

ANS: A, B, C, D, E Multiple external forces affect nursing. These include demographic changes in the population, human rights, increasing numbers of medically underserved, and the threat of bioterrorism. The women's movement brought greater sensitivity to the health care needs of women and the role of women in health care research.

The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses. The orthopedic unit has agreed to "float" two of its nurses to the oncology unit if oncology can "float" a nursing assistant to the orthopedic unit to help with obtaining vital signs. This is an example of (Select all that apply.) a. Autonomy. b. Accountability. c. Political activism. d. Politics.

ANS: A, B, D Staffing is an independent nursing intervention and is an example of autonomy. Along with increased autonomy comes accountability or responsibility for outcomes of an action. Nurses are involved in politics when seeking additional resources. However, political activism usually involves more than day-to-day activities such as unit staffing

Which of the following is (are) an example of an advanced practice nurse? (Select all that apply.) a. Nurse practitioner b. Clinical nurse specialist c. Patient advocate d. Certified registered nurse anesthetist e. Nurse midwife

ANS: A, B, D, E Although all nurses should function as patient advocates, "advanced practice nurse" is an umbrella term for an advanced clinical nurse such as a nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or nurse midwife.

After licensure, the practicing nurse is required to update his or her knowledge about the latest research and practice developments. The most common way nurses do this is through _____ programs. (Select all that apply.) a. Continuing education b. Master's degree c. In-service education d. DNP

ANS: A, C Continuing education updates the nurse's knowledge about the latest research and practice developments. In-service education programs are provided by a health care agency to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can provide the nurse with continuing education credit. Master's degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. The DNP is a practice doctorate that prepares advanced practice nurses.

Which concept means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided? a. Autonomy b. Accountability c. Patient advocacy d. Patient education

Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. As a patient advocate, the nurse protects the patient's human and legal rights and provides assistance in asserting these rights if the need arises. As an educator, the nurse explains concepts and facts about health, describes the reasons for routine care activities, demonstrates procedures such as self-care activities, reinforces learning or patient behavior, and evaluates the patient's progress in learning.

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 discuss the patient's wishes with them. The nurse is acting as the patients: 1. Education 2. Advocate 3. Caregiver 4. Case Manager

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.

The physician is planning to take the patient to surgery in the morning and leaves an order for the nurse to get the patient to sign the surgical permit. The physician's note indicates that the patient has been educated on the procedure. However, the patient tells the nurse, "I have no idea what he's going to do. He rushed in and rushed out so fast, I couldn't ask any questions." The nurse does not allow the patient to sign the permit and calls the physician to inform him of the patient's statement. This is an example of the nurse acting as a. Patient advocate. b. Patient educator. c. Manager. d. Clinical nurse specialist.

As a patient advocate, the nurse protects the patient's human and legal rights, including the right of the patient to understand procedures before signing permits. Although nurses can be educators, it is the responsibility of the surgeon to provide education for the patient in preparation for surgery, and it is the nurse's responsibility to notify the physician if the patient is not properly educated. Managers coordinate the activities of members of the nursing staff in delivering nursing care, and clinical nurse specialists are experts in a specialized area of nursing practice in a variety of settings.

An 18 yr. old woman 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

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

Responsibilities and Roles

Autonomy and accountability Caregiver Advocate Educator Communicator Manager

The nurse is caring for the patient who has had major abdominal surgery and also has a large sacral pressure sore. The nurse implements coughing and deep breathing exercises and consults the wound care specialist to evaluate and prescribe care for the pressure sore, even though no physician order has provided instructions to do so. In doing this, the nurse is implementing the element of a. Autonomy. b. Accountability. c. Advanced practice. d. Nurse practitioner.

Autonomy is an essential element of professional nursing. Some independent nursing interventions such as implementing coughing and deep breathing exercises and collaboration with other health professionals can be initiated without medical orders. Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. "Advanced practice nurse" is an umbrella term for advanced clinical nurses such as nurse practitioners who provide care to a group of patients.

The major difference between a baccalaureate degree nursing program and an associate's degree nursing program is that the baccalaureate program includes studies in a. Basic sciences and theoretical courses. b. Social sciences and humanities. c. Theoretical and clinical courses. d. Basic sciences and clinical courses.

Both associate's degree programs and baccalaureate programs focus on basic sciences and on theoretical and clinical courses. Baccalaureate programs, however, also focus on courses in the social sciences, arts, and humanities to support nursing theory.

Graduates of baccalaureate degree or associate's degree nursing programs are eligible to take which of the following to become registered nurses in the state in which they will practice? a. Continuing education credits b. In-service education programs c. National Council Licensure Examination d. Graduate education

Currently, in the United States, the most common way to become a registered nurse (RN) is through completion of an associate's degree or baccalaureate degree program. Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become registered nurses in the state in which they will practice. Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurse associations, professional nursing organizations, and educational and health care institutions. In-service education programs consist of 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. A nurse who is completing a graduate program can receive a master's degree in nursing.

How does knowledge of genomics affect patient treatment decisions?

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.

During the American Civil War, which of the following women was active in the Underground Railroad movement and assisted in leading more than 300 slaves to freedom? a. Harriet Tubman b. Clara Barton c. Dorothea Dix d. Mary Ann Ball (Mother Bickerdyke)

Harriet Tubman was active in the Underground Railroad movement and assisted in leading more than 300 slaves to freedom. Clara Barton, founder of the American Red Cross, tended soldiers on the battlefields, cleansing their wounds, meeting their basic needs, and comforting them in death. As superintendent of the female nurses of the Union Army, Dorothea Lynde Dix organized hospitals, appointed nurses, and oversaw and regulated supplies to the troops. Mother Bickerdyke organized ambulance services and walked abandoned battlefields at night, looking for wounded soldiers.

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

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

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

The American Red Cross was founded by a. Florence Nightingale. b. Harriet Tubman. c. Clara Barton. d. Mary Mahoney.

In 1882, the United States ratified the American Red Cross, founded by Clara Barton. Florence Nightingale established the Training School for Nurses in London, England, in 1860. Harriet Tubman was active in the Underground Railroad movement during the American Civil War. Mary Mahoney was the first professionally trained African American nurse.

Nurses working in the Henry Street Settlement in 1893 were among the first nurses to demonstrate autonomy in practice. This was because those nurses a. Had no ability to work in the hospital setting. b. Were required to use critical thinking skills. c. Focused solely on healing the very ill. d. Planned their care around research findings.

In 1893, nurses working in the Henry Street Settlement were some of the first to demonstrate autonomy in practice because they encountered situations that required quick and innovative problem solving and critical thinking, and provided therapies aimed at maintaining wellness, as well as curing the ill. Nursing hospitals expanded in the late nineteenth century and were major providers of nursing care. Not until the early twentieth century was there a movement toward a scientific, research-based body of nursing knowledge.

In 1923, the Goldmark Report was an important study that a. Formed formal nurse midwifery programs. b. Established the Center for Ethics and Human Rights. c. Revised the ANA code of ethics. d. Led to the development of the Yale School of Nursing.

In 1923, the Goldmark Report identified the need for increased financial support for university-based schools of nursing. As a result, the Yale School of Nursing was developed. Graduate nurse midwifery programs did not come into existence until the 1940s, and the Center for Ethics and Human Rights was founded in 1990. The ANA code of ethics was published in 1985 and was last updated in 2001.

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

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.

The student nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). It is important for the student to understand that the CRNA a. Works under the guidance of an anesthesiologist. b. Manages acute medical conditions. c. Manages gynecological services such as PAP smears. d. Must have a PhD degree in anesthesiology.

Nurse anesthetists provide surgical anesthesia under the guidance and supervision of an anesthesiologist, who is a physician with advanced knowledge of surgical anesthesia. Nurse practitioners, not CRNAs, manage self-limiting acute and chronic stable medical conditions; certified nurse midwives provide gynecological services such as routine Papanicolaou (Pap) smears. The CRNA is an RN with an advanced education in a nurse anesthesia accredited program. A PhD is not a requirement.

The nurse is speaking in front of a group of ninth grade students about nursing as a profession. One student states that she does not want to be a nurse because all nurses do is take care of sick people and play politics. The most appropriate response that the nurse could give and expand on is that a. Nursing is ideal for the person who hates politics. b. Nursing focuses on curing the person's disease. c. Nursing is not political because it has its own knowledge base. d. An area of nursing exists for every interest.

It is important to remember that opportunities are limitless for caring, compassionate, and competent nursing care; an area of nursing exists for every interest. Current philosophies and definitions of nursing demonstrate the holistic trend in nursing—to address the whole person in all dimensions, in health and illness, and in interaction with family and community. Political activism and commitment are a part of professionalism and are an important aspect of the delivery of health care. Nursing continues to draw on the social sciences and other fields as the focus of nursing care expands.

Health care reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform? 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

Moving from an acute illness to a health promotion, illness prevention model Health care reform also affects how health care is delivered. There is greater emphasis on health promotion, disease prevention, and management of illness.

Professional Nursing Organizations

NLN, ANA, ICN, SNA

The first practicing nurse epidemiologist was a. Florence Nightingale. b. Mildred Montag. c. Clara Barton. d. Mary Agnes Snively.

Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentery. Mildred Montag, Clara Barton, and Mary Agnes Snively came after Nightingale, each contributing to the nursing profession in her own way. Clara Barton founded the American Red Cross. Dr. Mildred Montag established the first associate degree nursing program in 1952. Mary Agnes Snively began forming the Canadian National Association of Trained Nurses in 1883.

A bill has been submitted to the State House of Representatives that is designed to reduce the cost of health care by increasing the patient-to-nurse ratio from a maximum of 2:1 in intensive care units to 3:1. The nurse realizes that a. Legislation is politics beyond the nurse's control. b. National programs have no bearing on state politics. c. The individual nurse can influence legislative decisions. d. Focusing on nursing care provides the best patient benefit.

Nurses can influence policy decisions at all governmental levels. One way is to get involved in ANA's national efforts, such as Nursing's Agenda for the Future: A Call to the Nation. This effort is critical in exerting nurses' influence early in the political process. Nurses need to become serious students of social needs, activists in influencing policy to meet those needs, and generous contributors of time and money to nursing organizations and candidates to help legislate conditions that are likely to produce the best care possible. (C)

The nurse has been working in the clinical setting for several years as an advanced practice nurse and has earned her master's degree as a family nurse practitioner. However, she seems unfulfilled and has a strong desire to do research. To fulfill her desire, the nurse most likely would apply to attend a program that would lead to a a. Doctor of Nursing Science degree (DNSc). b. Doctor of Philosophy degree (PhD). c. Doctor of Nursing Practice degree (DNP). d. Doctor in the Science of Nursing degree (DSN).

PhD programs emphasize basic research and theory and are research oriented. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. The DNP is a practice doctorate that prepares advanced practice nurses such as nurse practitioners.(B)

The examination for registered nurse (RN) licensure is exactly the same in every state in the US. 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

Provides a minimal standard of knowledge for an RN in practice; 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.

Which of the following resources guides faculty on structure and evaluation of the nursing curriculum? a. ANA's Standards of Nursing Practice b. Essentials of Baccalaureate Education c. NLNAC Interpretive Guidelines d. Standards of Professional Performance

The American Association of Colleges of Nursing (AACN) published Essentials of Baccalaureate Education for Professional Nursing: A Final Report (1998), which guides faculty on structure and evaluation of the curriculum and the performance of the graduate. The ANA's Standards of Nursing Practice demonstrates the critical thinking model known as the nursing process. Standards of Professional Performance describes a competent level of behavior in the professional role. NLNAC Interpretive Guidelines identifies core competencies for the professional nurse. (B)

The nurse spends time with the patient and family receiving 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

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.

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

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.

The patient requires routine gynecological services after giving birth to her son, and while seeing the nurse midwife, she asks for a referral to a pediatrician for the newborn. The nurse midwife should a. Provide the referral as requested. b. Offer to provide the newborn care. c. Refer the patient to the supervising physician. d. Tell the patient that she cannot make referrals.

The practice of nurse midwifery involves providing independent care for women during normal pregnancy, labor, and delivery, as well as care for the newborn. As an independent practitioner, supervising physicians are not required by the certified nurse midwife (CNM). However, a CNM practices with a health care agency that provides medical consultation, collaborative management, and referral. After being apprised of the CNM role, if the patient insists on seeing a pediatrician, the nurse midwife should provide the referral.

The nurse is caring for her patients and is focused on managing their care as opposed to managing and performing skills. This nurse demonstrates which level of proficiency according to Benner? a. Novice b. Competent c. Proficient d. Expert

The proficient nurse focuses on managing care as opposed to managing and performing skills. The novice nurse deals with a specific set of rules or procedures, which are usually stepwise and linear. The competent nurse understands the organization and the specific care required by specific types of patients and has experience with psychomotor skills. The expert nurse identifies patient-centered problems, as well as problems related to the health care system.

A nurse meets with the registered dietician 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 Eduction of Nurses (QSEN) competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Informatics

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 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 QSEN competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Informatics

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

Advanced beginner

a nurse that had some level of experience

Competent

a nurse who has been in the same clinical position for 2-3 years

Expert

a nurse with diverse experience

Proficient

a nurse with greater than 2-3 years

Novice

beginning nursing students

Expert clinical nursing practice

commitment to the application of knowledge and clinical experience

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 impt. Which of the following best describes this code? 1. improves self-health care 2. protects patients confidentiality 3. ensures identical care to all patients 4. defines the principles of right and wrong to provide patient care

defines the principles of right and wrong to provide patient care • 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.

Continuing education

involves formal, organized educational programs offered by universities, hospitals, state nurse associates, professional nursing organizations, and educational and health care institutions

In-service education

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

Critical thinking skills

• Ability to interpret clinical situations and make complex decisions • Based on fact, experience and standards of care • Reasoned thinking • Open to alternatives • Ability to reflect

Florence Nightingale

• Established the first nursing philosophy • Book "Notes on Nursing: what it is and what it is not" 1860 • First nurse epidemiologist Statistician • Implemented methods to improve sanitation and ultimately reduced illness, infection and mortality • Opened the first formal, fully organized nursing training school

Trends in Nursing

• Evidence-Based Practice • Quality and Safety: National safety goals, Quality and Safety Education for Nurses (QSEN) • Emerging Technologies • Genomics: Study of all genes • Perception of Nursing • Impact of nursing on politics and health policy

6 KSA's (knowledge, skills and attitudes)

• Patient centered care • Teamwork and Collaboration • Evidenced-Based Practice • Quality Improvement • Safety • Informatics

QSEN Project

• Quality and safety education for nurses • Overall goal is improve the quality and safety of health care systems by preparing future nurses

Code of ethics

•Philosophical ideals of right and wrong that define principles used to provide care; It is important for you to incorporate your own values and ethics into your practice.