Foundations of Nursing Practice ( Essential Concepts)
Identify and describe the five stages of illness behavior as explained by Suchman.
#1 no signs/symptoms (S/S) #2-Sick role (self-medicate) #3-medical care contract (seek physician) #4-dependent role (follows physician diagnosis/prescription plan) #5-recover & rehabilitation phase (returns to normal everyday activities)
What are the three essential components in informed consent?
#1- fully explain what the procedure involves (benefit vs. risk) #2- patient is able to understand & comprehend (language barriers, cognitive ability, non-sedated) #3- completely free of coercion
Differentiate the educational preparation requirements for nurses at the ADN and BSN levels
- ADN- Attend nursing classes at a 2-year college (usually a community college) earn an Associate's degree in Nursing-master same skills as BSN, but do not have extended courses in sciences and humanities, and other nursing courses - BSN- 4 year baccalaureate degree-curriculum includes leadership, research and community health; may go on to pursue MSN, DNP, PhD
Describe what is meant by the nursing profession having "autonomy" and give an example of how this is demonstrated
- Autonomy-Members have an internal authority to establish own standards of practice and standards of care-actions not dictated by others outside of this practice realm.
Define what the nursing process is and explain why it is essential to the practice of nursing.
- Nursing process-systematic, organized, step-by-step strategy-a means by which to provide quality care-is ongoing; is essential in order to individualize care. -Consists of assessment, diagnosis, planning, intervening, and evaluating
Which of the following traits are essential to a profession? Choose all that apply
- autonomy and orientation to service - unique body of formalized education and on-going research - organizations policies and standards
Differentiate beneficence from maleficence.
- beneficence: Acting in a way that benefits others -maleficence: Intentionally causing harm to others
Most theories relating to nursing practice address four major components. These include:
- person, health, philosophy of health/nursing, and purpose
Describe what is meant by veracity and explain how this relates to nursing scope of practice.
- veracity: being truthful and honest when communicating with patients and their families
Explain why secondary care is the most costly health services provided
-Acute problems/hospitalizations -Life threatening/critical situations -Complications of chronic diseases
Explain how the nursing profession is both an art and a science
-Art: Performing actions with characteristic style-the manner in which care is delivered-unique to the nurse and tailored to unique patient needs -Science: Making decision based on evidence from biological, psychological, and chemical sciences and practice expertise; use of the nursing process-scientific method of logical reasoning based in biology, chemistry, A&P, microbiology, & pharmacology
Describe the six major techniques that are used in gathering objective assessment data.
-Chart review-Medical record history -Consultation with physician or other HC providers -Observation-patient's immediate surroundings, safety -Palpation-feeling or touching -Percussion-thumping -Auscultation-listening, usually with stethoscope
What is a DRG? How does impact on health care is delivered?
-Classification of certain diseases/conditions that insurance companies believe are similar and therefore should meet certain predictable standards related to cost. -No individuality related to patient & care. Very restrictive & limiting for providing care.
Describe why four types of skill are required in the nursing profession
-Cognitive-Knowledge of A&P, microbiology, chemistry, nutrition, pathophysiology, pharmacology, G&D -Technical-Skills-procedures, VS, IVs, med administration -Communication-Therapeutic, respectful, clarifying, purposeful -Interpersonal-Maximization of use of self in interactions to accomplish patient-centered outcomes
Briefly explain the major theme of four major nurse theorists.
-Florence Nightingale: Environmental, fresh air, cleanliness -Virginia Henderson: 14 basic life needs, holistic approach -Martha Rogers: Dynamism and change -Callista Roy: Adaptation -Dorothea Orem: Self-care -Madeleine Leininger: Cultural sensitivity -Jean Watson: Caring
Compare and contrast nursing independent actions from dependent actions.
-Independent actions: What nurse can do and should do without being told-like keeping a safe environment -Dependent actions: Responsibilities ordered or authorized by the attending physician
Differentiate a medical diagnosis from a nursing diagnosis
-Medical Diagnosis: Medical conditions by physicians -Nursing Diagnosis: Human responses to actual or potential health problems
Describe what is included in a Nurse Practice Act. Explain why it is so important to nurses and why it is so important to health care consumers
-Nurse Practice Act-defines standards and practice guidelines for nursing -Importance RNs: Specifies actions to be taken by licensed nurses-assures public that RNs are practicing at a level of safety guaranteed safety of "do no harm". -HC Consumers: Assures provision of safe environment, assessment competency and in procedures, timeliness of monitoring, intervening & reporting in actions and documentation, specifies expectations of ethical and legal behaviors
Describe what is meant by respecting a patient's autonomy. Give an example.
-Patient's freedom to choose or not to choose in making health care decisions: properly obtaining a signed informed consent from patients
Differentiate primary, secondary, & tertiary care from primary, secondary, & tertiary prevention.
-Primary = Care is the 1st encounter with health care such as school nurse, workplace clinic. This is entry-level care. Normally s/s are not life-threatening. Prevention - healthy, no s/s, no disease, strategies to maximize health of individual. Ex—health education, healthy lifestyle choices, vaccinations. -Secondary = Care-increased level of care-unable to be taken care of in outpatient setting. Can be acute interventions, surgical. Normally in hospital. S/S can be life threatening/critical. Prevention- no s/s. + disease. Targets populations at risk. Screening, early detection. -Tertiary = Care-carrying for non-acute conditions that need assistance in ADLs. Ex-skilled nursing facilities, rehab, hospice care. Prevention- +s/s, + disease. Already have disease or condition. Goals are to maximize quality of life and prevention complications.
Describe what is meant by cultural sensitivity. How is this best accomplished in a nurse patient relationship?
-To meet the needs of each individual, nurses must be culturally sensitive, meaning, they are respectful at all times to the unique preferences of each patient. Nurses must learn what is important to each individual and strive to meet that need.
Briefly describe the major components required of a profession and describe how nursing, as a profession, meets these criteria
-Unique body of knowledge-Sciences of bio, chem, psychology, sociology and a specialized set of skills -Autonomy-Members' internal authority to set standards of practice and standards of care -Be service-oriented-Help humankind -Be research-based- Utilizing research evidence -Have code of ethics-Standards of care for betterment of patients -Have organization-Members can voice concerns and vote on practices (ANA)
Differentiate and give an example of each of the following: utilitarian, deontological, and principle-based ethics
-Utilitarian: Something is right or wrong based on the outcome: child picking neighbor's rose to please mother-wrong -Deontological: Based on the rightness or wrongness of act itself: taking of human life-death penalty is wrong -Principle-based: Based on certain principles that people most value: self-respect, honesty
Describe how the Whistle Blower Law and the Safe Harbor Law protects both patients and nurses.
-Whistle Blower Law: Protects nurse from retaliation when substandard practices are exposed-protects from being fired or blocked from employment because they exposed unsafe practice -Safe Harbor Law: Protects nurse from engaging in behaviors that potentially put patients at risk-like an in an unsafe staffing situation
Compare and contrast assault and battery and relate to nursing care.
-assault: Threat of harm, either bodily or personal, without patient's consent -battery: Direct physical contact that is not invited or encouraged by the patient
Compare and contrast slander and libel.
-slander: making verbal comments, true or not that are detrimental to the character or reputation of another -libel: written communication that is detrimental to the character and reputation of another
Identify and briefly describe the four major competency areas of standards of practice as specified by the boards of nursing.
1. Member of the profession (self-assessment, lifelong learning) 2. Provider of patient-centered care (safe, compassionate care) 3. Patient safety advocate (potential unsafe practices, prevent harm) 4. Member of the health care team (collaboration with other HC providers to facilitate care)
What were the Elizabethan Poor Laws? Describe how the carryover of these laws has impacted health care delivery in the United States.
Access to very poor & those unable to work due to illness/disability This is the basis of many welfare programs available today
Explain what is meant by the phrase: "If it wasn't documented, it wasn't done," and explain how this impacts on the legal and ethical practice of nursing.
Actions taken by nurses must be documented to provide information to other HC providers to enable the proper care to be taken of a patient. Many critical points may be overlooked without documentation. Without accurate documentation, nurses are vulnerable to legal action for negligence or failure to perform their duty
A patient refuses to have a pain medication by injection. A nurse says, "If you don't let me give you the injection, I will get help to hold you down and give it." With what crime might the nurse be charged?
Assault
Define homeostasis and describe how it relates to health.
Balance In health-forces that work together need to be balanced to achieve wellness
Which of the following health care practices are considered complementary to Western medical practices in the United States today? Choose all that apply.
Biofeedback Guided imagery
Which of the following has been a health care practice since very early in history?
Burial of the dead
Differentiate complementary and alternative health care practices and give two examples of each.
Complimentary -works with US protocols NutritionSupplements,massage/aroma/spiritual/chiropractic therapy, mind-body interventions Alternative—instead of US protocols Acupressure, Acupuncture, Reflexology, electromagnetic
Explain how the Patient Protection and Affordable Care Act (2010) address cost, access and quality health care.
Costs- reduced premiums and lower health care costs including financial assistance to consumers through reduced premiums and /or tax credits. Access- improved due to reduced costs thereby increasing access. Improves quality by providing preventive services at little or no cost, lifting any pre-existing condition restrictions from coverage, expanding age coverage for young adults, and providing consumer protection for health care delivery restrictions (cancellations, lifetime limitations, out of pocket costs).
In the US, which federal department oversees the health of the nation? And which other departments/ agencies are accountable to them?
Department of Health & Human Services (DHHS) CDC (Center for Disease Control) HUD (housing and urban development) OSHA (Occupational Safety and Health Administration) EPA, FDA, USDA, Disaster Response
What is duty as related to nursing practice? What is breach of duty?
Duty: what one is required to do by virtue of his or her license-for nurses it is: Accurate and complete assessment of patients Communication to those who need to know of any significant change in patient status Competently performing procedures without putting a patient at risk of harm or injury Breach of Duty: Failure to perform acts expected of persons with licensure (like failing to report unsafe situation)
Which of the following was enacted to counter the thinking that being poor and/or unable to work was a personal moral failing?
Elizabethan Poor Laws
Describe the three major types of nursing interventions and give at least one example of each type.
Facilitate accomplishment of the stated goals. -Assessment criteria- "Assess for pain by having patient score pain on scale of 1-10" -Nursing actions- "Administer pain medication" -Patient teaching- "Teach patient to maintain positioning"
Compare and contrast HMO and a PPO.
HMO- Emphasis on this coverage is to keep patients healthy because if the patient becomes ill, there are no further reimbursable funds. Primary care MD's are gatekeepers. PPO- Can access primary care MD's as well as specialists. Most insurance systems today are PPO's.
Differentiate an HMO from a PPO system in terms of how services are provided and how the health care providers are paid
HMO-select MD primary, prospective payment, focus is health promotion & disease prevention. All services go through primary MD (gatekeeper). PPO-**most common** can access any physician on preferred list. Focus is more to treatment (health restoration). Retrospective payment.
Which of the following health-related practices has been consistently present throughout history?
Hand Washing
.Which health practice is most universally identified throughout history as a deterrent to disease? Why is this?
Hand washing Why? Protective, aseptic
Identify at least three other laws in the U.S. that protect an individual's health and health information
Health Insurance Portability and Accountability Act (HIPAA) American with Disabilities Act Equal Opportunity Act
Describe the major GOALS of nursing and give at least two examples of each
Health promotion, health restoration, health maintenance. -Health promotion: teaching, motivating patient to engage in healthy lifestyle practices -Health restoration: care of patients needing medications or physical therapies -Health maintenance: (minimize potential consequences)help patients have routine screening tests, helping patients with chronic conditions
What information is mandated by HIPAA to be given to patients on admission to a health care facility
How health care information will be used
A new arena of nursing practice in which nurses retrieve, analyze, organize and communicate data related to patient care is know as....
Informatics
Insurance companies would best be described as a system of
Managed care
Compare and contrast Medicare and Medicaid related to eligibility, premiums, and coverage.
Medicare (age >65-part A, end stage renal, disabled) A-cover >65, free **limit amount of days B- 80% of visits covered C- new (combines A+B+D) D- with part A—Medications (additional premium deductible) Medicaid (dispersed at state level—for the poor (poverty level)) All ages, covers all expenses, medical '0' premiums, Vision/Dental extra premiums.
Which of the following health-related policies provides patients with the right to have a power of attorney?
Patient Self-Determination Act
Explain what it means that goals should be measurable.
Planning stage of nursing process-need to be objectively measured and include a realistic time frame-must be able to objectively measure if a goal was met or not by establishing specific criteria that must be met to be considered achievement of a goal
A nurse has taken a telephone order from a physician for an emergency medication. The dose of the medication is abnormally high. What should the nurse do next?
Question the order for the medication
Which of the following health care delivery settings is the most costly?
Secondary care
Which of the following prevention modes is targeted to those at risk for disease or injury?
Secondary prevention
Compare and contrast Smith's Model of Health with Travis' Model of Health
Smith model looking at how an individual moves through the stages of illness back to health #1-no signs/symptoms #2-signs/symptoms present but able to work as before #3-needs to adapt to signs/symptoms of illness #4-exuberent sense of well-being Travis model shows health as a dynamic movement. One with no sign/symptoms of disease can move toward wellness. If sign/symptom are present—treatment will move individual toward wellness (no s/s). Failure to complete treatment can lead the opposite direction towards premature death.
Name three notable nurses and describe the contribution that they made to health and health care delivery.
Some include: Florence Nightingale- Mother of Nursing Clara Barton-American Red Cross Lillian Wald-created Henry Street Settlement House/Public Health Nursing Harriet Tubman-Civil war nurse, Abolitionist Breckenridge-Frontier Nursing Service Dorothea Dix- Advocate for the mentally ill, army nurse corps during civil war Mary Adelaide Nutting- 1st professor of nursing Lavinia Dock- Nurse academician, Women suffrage
Differentiate subjective data from objective data as related to the assessment component of the nursing process and give one example of each.
Subjective data-Obtained directly from patient by asking questions when taking a health history (Do you exercise on a regular basis?) Objective data-Obtained by chart review, consult with the physician and other HC providers, observation, palpation, percussion, and auscultation
Explain why communication is essential to providing quality nursing care. Describe with whom the nurse needs to communicate and when.
The nurse is legally and ethically responsible for communicating with other nurses and HC providers. Nurse give report to other nurses during shift change to provide for continuity of care.
Which of the following is NOT part of The Patient Protection and Affordable Care Act (2010)?
Transportation services for all health care services
Describe how Maslow's Hierarchy of Needs relates to the prioritization of nursing diagnoses
Used to determine priority diagnosis for patients-physiological needs given priority-breathing and circulation before all else
Describe how people develop values and explain how personal values might differ from professional ethics.
Values are what people hold dear, they are learned, developed from environmental upbringing-parents-significant persons, personal experiences
Which of the following are considered outcome competencies of Standards of Practice under most Nurse Practice Acts (select all that apply)
a. Provider of Patient-Centered Care b. Member of the Profession c. Member of the Health Care team d. Patient Safety Advocate
What is Health People 2020? Identify the main overall objectives.
global priority health-related concerns AND specific concerns within US Objective: increase healthy years of living & minimize health care disparities
Nurses function in many different arenas but which of the following are considered the goals of nursing wherever care is provided?
health promotion, health restoration, health maintenance
Describe what is meant by justice in nursing practice. Give an example.
justice: Being equal and fair in treatment proceedings
Identify two major scientific discoveries that have had a major impact on health and health care delivery.
multiple discoveries noted. Some include: Pasteur-pasteurization, Lister-antisepsis/sterilization, Small pox Vaccine - Edward Jenner and Fleming-Penicillin (PCN)
Which type of assessment data is obtained when taking vital sign?
objective
What form of assessment can and should be done upon every entry to a patient's room?
observation
NANDA diagnoses are composed of 3 parts. These are
patient response to condition, diagnosis/prognosis, and symptomatology
Which of the following should be given priority when establishing a nursing care plan?
physiologic needs
Which of the following best describes palpation?
touching
What health-related issues were addressed by the Social Security Act of 1935? Please be specific.
young children—adequate nutrition and medical care Healthcare providers—properly educated & licensed