Module 11: Final

Nursing Process

- Assessment: The assessment phase primarily establishes the database on which the rest of the nursing process is built. - Analysis: The analysis phase of the nursing process involves developing and using a nursing diagnosis for the care of the client. - Planning: The planning phase of the nursing process primarily involves setting goals for the client. - Intervention/Implementation: The intervention and implementation phase of the nursing process involves identifying nursing actions that are required to meet the goals stated in the planning phase. - Evaluation: The evaluation phase of the nursing process determines whether the goals stated in the planning phase have been met through the interventions.

Environmental blockers

- Experiencing change - Grief experiences - Stressful situations - Policy change - Tension and anxiety -

Identify why it is important for nurses to join professional organizations

- National nursing organizations need the participation and membership of all nurses in order to claim that they are truly representative of the profession. A large membership allows the organization to speak with one voice when making its values about health-care issues known to politicians, physicians' groups, and the public in general.

Describe the different spiritual practices

- Nurturing the spirit - Prayer and meditation - Relief Through Imagery - Relaxation Response - Remembered Wellness - The Nocebo Effect (If a client is told something bad is going to happen to them and believes it, the likelihood of it happening increases) - A Quiet Focus - Peace Through Awareness - Visualizing an Outcome - Therapeutic Touch

How to identify quality care and providers

- Quality Health-Care Plan - Quality Physician(s) - Quality Hospital

Define ways a professional organization can impact nursing

- The establishment of a professional organization is one of the most important defining characteristics of a profession. - By working together for a specific purpose, an association or organization amplifies its impact, and by developing a strategic plan, it focuses that impact to achieve certain results. - Professions with just one major organization generally have a great deal of political power.

Know and be able to identify what tasks can be delegated to a LPN (LVN) if a patient is stable

- vital signs - uncomplicated skills - stable clients - chronic diseases - oral and IM meds

What are the 6 aims for improvement of quality of care according IOMS 2nd report?

1. Safe: Avoiding injuries to clients from the care that is intended to help them. 2. Effective: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit. 3. Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. 4. Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care. 5. Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy. 6. Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

How many deaths per year were reported and for what reason?

98,000 people die per year due to adverse events and medical errors in hospitals

Breach of Confidentiality

A breach of confidentiality results when a client's trust and confidence are violated by public revelation of confidential or privileged communications without the client's consent. Most breach of confidentiality cases involve a physician's revelation of privileged communications shared by a client. Privileged client information can only be disclosed if it is authorized by the client.

Ethical Code

A code of ethics is a written list of a profession's values and standards of conduct. The code of ethics provides a framework for decision-making for the profession and should be oriented toward the daily decisions made by members of the profession.

Define civility and examples of civility in nursing education

A simple definition of civility is for people to treat others as they would wish to be treated (the Golden Rule). Being civil to each other, to students, to colleagues, and to clients promotes emotional health and creates a positive environment for learning and for the promotion of healing. It also develops emotional intelligence and empathy in nurses.

Invasion of privacy

A violation of a person's right to protection against unreasonable and unwarranted interference with one's personal life. As proof the client must show that (1) the nurse intruded on the client's seclusion and privacy, (2) the intrusion is objectionable to a reasonable and prudent person, (3) the act committed intrudes on private or published facts or pictures of a private nature, and (4) public disclosure of private information was made.

Define Quality assurance

Activity conducted in health-care facilities that evaluates the quality of care provided to ensure that it meets pre-established quality standards.

Encoding definition, what can interfere with the encoding process?

After the sender sends the message, the receiver has a responsibility to listen to, process, and understand (encode) the information and then to respond to the sender by giving feedback (decoding). The encoding process occurs when the receiver thinks about the information, understands it, and forms an idea based on the message. Several factors can interfere with the encoding process. On the sender's side, these can be factors such as unclear speech, convoluted and confused message, monotone voice, poor sentence structure, inappropriate use of terminology or jargon, or lack of knowledge about the topic. On the receiver's side, factors that may interfere with encoding include lack of attention, prejudice and bias, preoccupation with another problem, or even physical factors such as pain, drowsiness, or impairment of the senses.

Know and be able to identify what tasks a RN can delegate to an LPN or CNA/UAP

Although LPNs and LVNs can do most skills, for the NCLEX they: • Cannot do admission assessments. • Cannot give intravenous (IV) push medications. • Cannot write nursing diagnoses. • Cannot do most teaching. • Cannot do complex skills. • Cannot take care of clients with acute conditions. • Cannot take care of unstable clients. For questions concerning UAPs, CNAs, and aides on the NCLEX: • Look for the lowest level of skill required for the task. • Look for the least complicated task. • Look for the most stable client. • Look for the client with the chronic illness.

Theory

As nursing informatics evolved, it began to combine nursing theory and informatics. Without a well-articulated theoretical basis to guide the gathering of data, nurses soon become overwhelmed with meaningless data and information. Obviously, there is a need for common definitions, a standardized nursing language, and criteria for organization of the data.

Assertive

Assertive communication is the preferred style in most settings. It involves interpersonal behaviors that permit people to defend and maintain their legitimate rights in a respectful manner that does not violate the rights of others. Assertive communication is honest and direct and accurately expresses the person's feelings, beliefs, ideas, and opinions.

Know and be able to identify the characteristics of a task that warrants a task to be assigned by an RN

Assignment, on the other hand, is designating tasks for ancillary personnel that fall under their own level of practice according to facility policies, position descriptions, and, if applicable, state practice act.

Developing cultural awareness starts where?

At home. Nurses must first understand their own cultural backgrounds and explore the origins of their own potentially prejudiced and biased views of others.

How do you assess culture?

Because clients from different cultures may feel uncomfortable revealing information about cultural beliefs, values, and practices to strangers, it is a good idea to begin your assessment by asking some general questions. A client is more likely to trust a nurse who demonstrates interest in that person as an individual. Only after a warm and trusting environment has been established will a client be willing to reveal the more personal aspects of his or her culture to the nurse. • Why do you think you are ill? What was the cause of the illness? • What was going on at the time the illness started? • How does the illness affect your body and health? • Do you consider this to be a serious illness? • If you were at home, what type of treatments or medications would you use? How would these treatments help? • What type of treatment do you expect from the health-care system? • How has your illness affected your ability to live normally? • If you do not get better, what do you think will happen?

HIPAA

Because of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, health-care providers have become more aware than ever of the issue of confidentiality in the health-care setting.

Verbal builders & blockers

Builders: - Encouraging words - Asking open-ended questions - Use "I" rather than "you" messages - Asking clarification questions - Reflecting feelings and emotions - Repeating what was just said - Never, never interrupt - Reviewing what was said - Acknowledging what was said Blockers: - Automatic defensiveness - Asking closed-ended questions - Accusing or blaming - Using sarcasm - Constant interruptions - Judging, name calling, and diagnosing - Stating opinions as proven facts - Making generalizations, being patronizing, and offering vague reassurances - Telling people how they should feel - Changing the subject - Expecting mind reading - Shaking or pointing a finger while speaking - Walking away

Nonverbal Builders & blockers

Builders: - Eye contact. - Stop what you're doing - Nod the head - Positive facial expressions - Sitting or standing in close proximity - Open posture, directly facing - Listening emphatically - Light touch - Being aware of the speaker's nonverbal and paraverbal communication Blockers - Eye rolling - Arm and leg folding - Slouching, hunching, turning away. - Fidgeting - Deep, loud sighs - Multiple watch or clock checks - Continuing with an activity while the other person is talking - Failure to make eye contact - Tuning out or failing to pay attention

Define Root Cause Analysis

Client records and occurrence/ incident reports are used to track and analyze the occurrences. The analysis, often called root cause analysis, tracks events leading to error, identifies faulty systems, and processes and develops a plan to prevent further errors.

Define Client satisfaction

Client satisfaction is another way to measure quality of care. The Hospital Care Quality Information from the Consumer Perspective (HCAHPS) initiative began in 2008 and provides a standardized survey instrument and data collection method to obtain client satisfaction data on eight key topics: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medications, discharge information, cleanliness of environment, and quietness of hospital environment.

What are the 4 concepts common to all nursing theories?

Client, health, environment, and nursing.

Understand the Nursing Code of Ethics and its purpose

Codes of ethics are presented as general statements and thus do not give specific answers to every possible ethical dilemma that might arise. However, these codes do offer guidance to the individual practitioner in making decisions.

Information

Consists of data that have been given form and have been interpreted. If the numbers 102 and 104 are given additional descriptors so that they become a 25-year-old man with an oral temperature of 102°F and a heart rate of 104 beats per minute (bpm) taken on admission to the emergency room, they become information that has meaning to the nurse.

Discuss and Define Culture

Culture may be seen as a group's acceptance of a set of attitudes, ideologies, values, beliefs, and behaviors that influence the way the members of the group express themselves. It is a collective way of thinking that distinguishes one relatively large group from another over generations. An individual's cultural orientation is the result of a learning process that literally starts at birth and continues throughout the life span. Behaviors, beliefs, and attitudes are transmitted from one generation to the next.

Describe the characteristics defining "spiritual distress" as a nursing diagnosis

Defining characteristics of spiritual distress include concerns with and questions about the meaning of life and death, anger toward God, concerns about the meaning of suffering, concerns about the person's relationship to God, the inability to participate in preferred religious practices, seeking spiritual help, concerns about the ethics of prescribed medical regimens, preoccupation with illness and death, expressing displaced anger toward clergy, sleep disturbances, and altered mood or behavior. Spiritual distress may occur in relation to separation from religious or cultural supports, challenges to beliefs and values, or intense suffering.

Know the steps of Delegation

Delegation is recognized as designating ancillary personnel for the responsibility of carrying out a specific group of nursing tasks in the care of certain clients. Delegation includes the understanding that the authorized person is acting in the place of the RN and will be carrying out tasks that generally fall under the RN's scope of practice. However, the person taking on the RN-level task must be qualified to perform the task within the nurse's state practice act.

Define Diversity

Diversity is a term used to explain the differences between cultures. The characteristics that define diversity can be divided into two groups: primary and secondary. 1. Primary characteristics tend to be more obvious, such as nationality, race, color, gender, age, and religious beliefs. 2. Secondary characteristics include socioeconomic status, education, occupation, length of time away from the country of origin, gender issues, residential status, and sexual orientation. These may be more difficult to identify, yet they may have an even more profound effect on the person's cultural identity than the primary characteristics.

Origin of nursing research

Florence Nightingale is viewed as the person who first elevated nursing to the status of a profession. Nightingale believed in the importance of "naming nursing" through the collection and use of objective data. She also used this data to prove that there was a need for wide-ranging health-care reforms, including clinical practices, treatment of injured soldiers, and nursing education.

Identify the principle upon which Nightingale's spirituality was based

For Nightingale, spirituality involved a sense of a divine intelligence that creates and sustains the cosmos, and she had an awareness of her own inner connection with this higher reality. The universe, for Nightingale, was the embodiment of a transcendent God. She came to believe that all aspects of creation are interconnected and share the same inner divinity. She believed that all humans have the capacity to realize and perceive this divinity. Nightingale's God can be described as perfection or as the "essence of benevolence."

General Systems Theory (open systems and closed systems)

Generally understood as an organized unit with a set of components that interact and affect each other, a system acts as a whole because of the interdependence of its parts. As a result, when part of the system malfunctions or fails, it interrupts the function of the whole system rather than affecting merely one part. Open systems are those in which relatively free movement of information, matter, and energy into and out of the system exists. In a completely open system, there would be no restrictions on what moves in and out of the system, thus making its boundaries difficult to identify. Theoretically, a closed system prevents any movement into and out of the system. In this case, the system would be totally static and unchanging.

Define Culturally Competent Care

Health care is considered culturally competent when health-care providers and institutions are able to provide care for clients that meet the clients' cultural needs. Ultimately, cultural competency leads to high-quality care to every client regardless of language, race, or ethnic background.

Define nursing informatics

Health informatics is a more comprehensive term, defined as the use of information technology with information management concepts and methods to support health-care delivery. An early model for nursing informatics can be traced back to 1989. Although somewhat simplistic, it primarily combined computer science, information science, and nursing science in a manner that would help the nurse in planning and delivering care. These technologies aid in the collection and analysis of data so that the nurse can make informed and accurate decisions about the type of care clients require. Nursing science is all the research data from nursing and other associated disciplines that relate to and support nursing practice.

Identify the "father of modern medicine" and key historical persons who advanced the nursing profession

Hippocrates was called "the father of medicine. Key historical Persons: - Florence Nightingale: Founder of modern nursing - Isabel Adams Hampton: Advocate for nursing education - Lillian Wald: First president of the National Organization for Public Health Nursing. She was the first to place nurses in public schools. Also founded Henry St. Settlement House - Lavinia Lloyd Dock: Advocate for equal rights/women's suffrage movement. - Annie W. Goodrich: Leader in Nursing education; dean of Yale SON; also leader in army nursing education - Loretta C. Ford: Credited with founding nurse practitioner (NP) practice

Hospice

Hospice care emphasizes physiological and psychological support for clients who have terminal diseases. Hospice care provides a variety of services in a caring and supportive environment to terminally ill clients, their families, and other support persons. The central concept of hospice care is not saving life, but improving or maintaining the quality of life until death occurs.

What is a model?

Hypothetical representation of something that exists in reality. The purpose of a model is to attempt to explain a complex reality in a systematic and organized manner.

What are the key factors to high-quality care?

IOM, QSEN, and AACN's Essentials of Nursing Education all agree on the importance of scholarship, research, and evidence-based practice in ensuring quality and safety in health care.

Values

Ideals or concepts that give meaning to an individual's life. Values are derived most commonly from societal norms, religion, and family orientation and serve as the framework for making decisions and taking action in daily life.

What do nursing models and theories do for nursing practice, and our profession?

In this nursing context, the goal of a theory is to describe and explain a particular nursing action to make a hypothesis, which predicts the effect on a client's outcome, such as improved health or recovery from illness. Nursing theory should provide the principles that underpin practice and help to generate further nursing knowledge. Although a model tends to be more concrete than a theory, they both help explain and direct nursing actions.

Identify and discuss the importance of interprofessional education for nurses

Interprofessional education is defined as "two or more students from different professions learning about, from and with each other to enable effective collaboration and improve health outcomes." ; increasing the communication skills between health-care professionals and promoting a spirit of teamwork would decrease errors and improve the quality of care.

Who can a RN delegate to?

LPN's/LVN's, CNA, UAP

Dorothy E. Orem's Self-Care Model

Model of nursing based on the belief that health care is each individual's own responsibility. The aim of this model is to help clients direct and carry out activities that maintain or improve their health. Client: The central element of this model is the client, who is a biological, psychological, and social being with the capacity for self-care. Health: Health is defined as the person's ability to live fully within a particular physical, biological, and social environment, achieving a higher level of functioning that distinguishes the person from lower life-forms. Self-Care: The first type of self-care is called universal self-care and includes those elements commonly found in everyday life that support and encourage normal human growth, development, and functioning. Health deviation self-care includes those activities carried out by individuals who have diseases, injuries, physiological or psychological stress, or other health-care concerns. Environment: the medium through which clients move as they conduct their daily activities; Environment includes social interactions with others, situations that must be resolved, and physical elements that affect health. Nursing: The primary goal of nursing in this model is to help the client conduct self-care activities in such a way as to reach the highest level of human functioning; As clients become less able to care for themselves, their nursing care needs increase. - Wholly compensated care: A person who is able to carry out few or no self-care activities falls into the wholly compensated nursing care category, in which the nurse must provide for most or all of the client's self-care needs. - Partially compensated care: Clients in the partially compensated category of nursing care can meet some to most of their self-care needs but still have certain self-care deficits that require nursing intervention. - Supportive developmental care:Clients who are able to meet all of their basic self-care needs require very few or no nursing interventions; nurse's main functions are to teach the client how to maintain or improve health and to offer guidance in self-care activities and provide emotional support and encouragement. Three Step Process: - Assessment - Plan of care - Implementation

Non-assertive

Non-assertive communication is also referred to as submissive communication. When people display submissive behavior or use a submissive communication style, they allow their rights to be violated by others. Their requests and demands are surrendered to others without regard to their own feelings and needs.

Telehealth

Nurses answer the phones, supply answers to health-related questions, and advise callers on how to handle nonurgent health situations.

Distinguish between spirituality and religion

On the basis of these themes, spirituality is defined as a way of life, usually informed by the moral norms of one or more religious traditions through which a person relates to other persons, the universe, and the transcendent in ways that promote human fulfillment (of self and others) and universal harmony. Definitions of religion usually identify a specific system of values and beliefs and a framework for ethical behavior that the members must follow. Religion can be thought of as a social construct that reflects its cultural context and specific philosophical influences.

Know and be able to identify the what is the scope of practice of an RN, LPN is, along with what tasks a CNA/UAP can do.

One large group of health-care workers to whom RNs delegate is generally called unlicensed assistive personnel (UAP). This group includes individuals who have been through some type of training program ranging from a few hours up to several months. The ANA Code of Ethics for Nurses states, "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" (statement 4). The task should not require excessive supervision, complex decision-making, or detailed assessment during its performance. If any of these elements are required, it needs to be reassigned to an RN.

Beneficence

One of the oldest requirements for health-care providers, views the primary goal of health care as doing good for clients under their care.

Why is heritage consistency important?

Ostensibly, they "Americanize" by wearing business suits, speaking English, eating American food, and engaging in traditional American hobbies. However, when they are at home, or with groups from their nation's culture, they speak their native language, wear traditional clothes, eat native meals, and generally follow their native customs. This approach to acculturation has the advantages of allowing them to fit in and advance within the larger culture, while retaining many of the cultural elements that feel like home, which provides a sense of stability in their lives.

Determine the main method in which nurses can gain power in nursing

Probably the first, and certainly the most important, way in which nurses can gain power in all areas is through professional unity. The most powerful groups are those that are best organized and most united.

Define QSEN

Quality & Safety Education for Nurses

Know the Role and Scope of practice of a RN, LPN, or CNA/UAP and who could perform a history and a physical on a new patient

RN - Admission assessment - IV meds - blood products - care plan - client teaching - unstable clients - acute diseases LPN - vital signs - uncomplicated skills - stable clients - chronic diseases - oral and IM meds UAP - feedings - basic hygiene - basic skills - stable clients - chronic diseases - ambulation

Data

Raw and unstructured facts. For example, the numbers 102 and 104 are raw data: By themselves, these numbers have little meaning because they lack interpretation.

Rehabilitation Centers

Rehabilitation centers or units are similar to some extended care facilities, where the client goal is to restore health and function at an optimum level. Often clients are admitted to rehabilitation units after recuperating from the acute stage of an injury or illness. The rehabilitation unit then provides services to complete the recovery and restore a high degree of independence.

What is a theory?

Set of interrelated constructs (concepts, definitions, or propositions) that presents a systematic view of phenomena by specifying relations among variables with the purpose of explaining and predicting phenomena.

Resolving conflict strategies & how approached by different personalities.

Several different strategies can be used to resolve workplace conflicts. Depending on a person's communication style and personality traits, different outcomes may occur. People who use an assertive style of communication and incorporate the communication builders have much greater success in the positive resolution of conflicts.

Define evidence-based practice

Simply stated, evidence-based practice is the practice of nursing in which interventions are based on data from research that demonstrates that they are appropriate and successful.

Define spirituality

Spirituality is a broad and somewhat nebulous concept that has to do with the search for answers to certain questions and issues. Spirituality can be defined from both religious and secular perspectives. A person with spiritual needs does not necessarily have to participate in religious rituals and practices.

Strategy 1 Conflict Resolution:

Strategy 1: Ignore the Conflict • Submissive personality: Person avoids bringing the issue to the other through fear of retaliation or ridicule if he or she confronts and expresses honest feelings or opinions. • Assertive personality: Ignoring the conflict is never an option. They will almost always use strategy 2. • Aggressive personality: Person has decided not to pursue the conflict because the other person is "too stupid to understand" or it would just be a "waste of my time."

Strategy 2 Conflict Resolution:

Strategy 2: Confront the Conflict • Submissive personality: Person does not handle the situation directly but refers the problem to a supervisor or to another person for resolution. • Assertive personality: Person sets up a time and place for a one-on-one meeting. At the meeting, the two parties focus on the issues that caused the conflict and negotiate to define goals and problem-solve. If conflict is more severe, the parties may resort to negotiation or mediation (see below). • Aggressive personality: Person confronts the other loudly, in front of an audience, and attacks the other's personality rather than the issue. Person either walks away before the other can speak or keeps talking without stopping and does not allow the other person to respond. The communication is strictly one-sided and very negative.

Strategy 3 Conflict Resolution:

Strategy 3: Postpone the Conflict • Submissive personality: Person keeps track of the issues until they reach a critical point, then dumps all the issues at one time on the offender in a highly aggressive manner. The other person generally has no idea why he or she is being attacked and may respond with anger or submission. • Assertive personality: Hardly ever uses this method except to allow the other person to "cool down" and become more receptive to what others have to say. • Aggressive personality: Person waits until he or she can either use the incident as a threat or blackmail or express the conflict in front of an audience.

Knowledge

Takes the process one step further because it is a synthesis of data and information. Knowing that an oral temperature of 102°F is higher than normal and a heart rate of 104 bpm is faster than normal for a 25-year-old man, and combining that information with an understanding of human physiology and pharmacology, the nurse is able to decide what treatment should be given.

Define quality of care

The Institute of Medicine (IOM) defines quality as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."

Define sentinel events

The Joint Commission defines a sentinel event as an "unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury includes loss of limb or function."

What is the leapfrog program and what is it referred to as now?

The Leapfrog Group's mission is to promote giant leaps forward in the safety, quality, and affordability of health care by: • Supporting informed health-care decisions by those who use and pay for health care • Promoting high-value health care through incentives and rewards. Leapfrog's goal is to promote high-quality health care through incentives and rewards. Referred to as the Leapfrog Group

List the QSEN competencies and relationship to nursing education

The Quality and Safe Education for Nurses (QSEN) project, built upon the IOM recommendations, is in the process of developing a framework for nursing schools' curricula. Nurses must have these 6 competencies upon graduation of their program: • Client-centered care. • Teamwork and collaboration. • Evidence-based practice (EBP). • Quality improvement (QI). • Safety. • Informatics.

Know the important factors an RN must consider when assigning unit staff assignment.

The delegating nurse needs to know the availability of staff and the education and competency levels of the personnel to be delegated. These factors must be matched with the level of care required by the client.

Define just cultural organization

The establishment of a positive work environment that has a commitment to safety and quality, transparency, and using errors as learning opportunities and allowing employees to report errors and near misses voluntarily and anonymously. Also called a blame-free culture.

Advance Directive

The expressed desires about future medical care are known as advance directives. They are the best means to guarantee that a client's wishes will be honored.

Morals

The fundamental standards of right and wrong that an individual learns and internalizes, usually in the early stages of childhood development.

Home-Healthcare setting

The goal of home health care is to make it possible for clients to remain at home rather than use hospital, residential, or long-term care facilities. Clients experience lower stress levels at home and have a more positive outlook, which studies have shown hastens recovery.

Why is biological/physical cultural variations important?

The interpretation of assessment findings may be affected by ethnic variations in anatomical structure or characteristics (e.g., children from some Asian cultures may fall below the normal growth level on a standardized American growth chart because of their genetically smaller stature).

Roy Adaption Model

The main goal of this model is to allow the client to reach his or her highest level of functioning through adaptation. Client: Man is viewed as a dynamic entity with both input and output. As derived from the context of the four modes in the Roy Adaptation Model, the client is defined as a biopsychosocial being who is affected by various stimuli and displays behaviors to help adapt to the stimuli. Health: In the Roy Adaptation Model, the concept of health is defined as the location of the client along a continuum between perfect health and complete illness. In this model, health is rarely an absolute. Rather, "a person's ability to adapt to stimuli, such as injury, disease, or even psychological stress, determines the level of that person's health status." Environment: The environment consists of all those factors that influence the client's behavior, either internally or externally. This model categorizes these environmental elements, or stimuli, into three groups: (1) focal, (2) contextual, and (3) residual. - Focal stimuli are environmental factors that most directly affect the client's behavior and require most of his or her attention. - Contextual stimuli form the general physical, social, and psychological environment from which the client emerges. - Residual stimuli are factors in the client's past, such as personality characteristics, past experiences, religious beliefs, and social norms, that have an indirect effect on the client's health status. Nursing: Nursing becomes a multistep process, similar to the nursing process, to aid and support the client's attempt to adapt to stimuli in one or more of the four adaptive modes. - assessment - analysis - goals

Fidelity

The obligation of an individual to be faithful to commitments made to himself or herself and to others.

Justice

The obligation to be fair to all people.

List the skills necessary of the nurse to provide culturally competent care

The primary skills required for cultural competence include communication, understanding, and sensitivity.

Veracity

The principle of truthfulness. It requires the health-care provider to tell the truth and not to intentionally deceive or mislead clients.

How many competencies were developed by the IOM (define IOM) - what are the competencies?

The project, QSEN, is built on five competencies initially developed by the IOM: • Client-centered care • Teamwork and collaboration • Evidence-based practice (EBP) • Quality improvement (QI)18 • Safety

Quantitative vs Qualitative research

The purpose of qualitative inquiry is to gain an understanding of how individuals construct meaning in their world, visualize a situation, and make sense of that situation. Quantitative designs use approaches that seek to verify data through prescriptive testing, correlation, and sometimes description. These designs imply varying degrees of control over the research material or subjects.

Non-maleficence

The requirement that health-care providers do no harm to their clients, either intentionally or unintentionally.

Clinic

The responsibilities of nurses who work in physicians' offices or in general clinics include obtaining personal health information and histories of current illness and preparing the client for examination. Nurses also assist with procedures and obtain specimens for laboratory analysis.

Autonomy

The right of self-determination, independence, and freedom. It refers to the client's right to make health-care decisions for himself or herself, even if the health-care provider does not agree with those decisions.

Define therapeutic touch

Therapeutic touch (TT) is an active alternative healing modality that involves redirecting the human energy system. The practitioner of TT acts with the intent of relaxing the recipient, reducing pain and discomfort, and accelerating healing when appropriate.

Assisted-Living

These centers consist of separate apartments or condominiums for the residents and provide amenities such as meal preparation and laundry services.

Long-term Care

These services are provided for both elderly and younger clients who have similar needs, such as clients with spinal cord injuries. The current trend in extended care facilities is to provide care in a homelike atmosphere and base programs on the needs and abilities of the clients, or residents as they are commonly called, of the facility.

Occupational Health

These services range from providing exercise facilities and fitness programs to health screenings and referrals. Illness prevention focuses on topics such as smoking cessation, stress management, and nutrition. Although some companies may hire health educators to manage their clinics, community health nurses often provide these services.

King Model

This model also notes that nursing must function in all three system levels found in the environment: Personal, interactional, and social. The primary function of nursing is at the personal systems level, where care of the individual is the main focus. However, nurses can effectively provide care at the interactional systems level, where they deal with small to moderate-sized groups in activities such as group therapy and health-promotion classes. Finally, nurses can provide care at the social systems level through such activities as community health programs. Client: Main focus is the client; viewed as an open system that exchanges energy and information with the environment—a personal system with physical, emotional, and intellectual needs that change and grow during the course of life; interpersonal systems are developed through interactions with others, depending on the client's perceptions of reality, communications with others, and transactions to reduce stress and tension in the environment. Environment: The personal and interpersonal systems or groups are central to King's conception of environment. - Personal: interchange takes place between two individuals who share similar goals - client/nurse rel. - Interpersonal: involve relatively small groups of individuals who share like goals - weightloss group - Social: include the large, relatively homogeneous elements of society. The health-care system, government, and society in general are some important social systems. As the person moves through the world, the physical setting interacts with the personal system to either improve or degrade the client's health-care status. Health: Viewed as a dynamic process that involves a range of human life experiences, health exists in people when they can achieve their highest level of functioning. Health is the primary goal of the client in the King model. Nursing: Nursing is a multifaceted process that includes a range of activities such as the promotion and maintenance of health through education, the restoration of health through care of the sick and injured, and preparation for death through care of the dying. Five elements to nursing process: - action - reaction - interaction - transaction - feedback

Neuman Health-Care Systems Model (including stressor and levels of intervention)

This model focuses on the individual and his or her environment and is applicable to a variety of health-care disciplines apart from nursing. Client: viewed as an open system that interacts constantly with internal and external environments through the system's boundaries; The client-system's boundaries are called lines of defense and resistance in this model and may be represented graphically as a series of concentric circles that surround the basic core of the individual. The general goal of all these protective boundaries is to maintain the internal stability of the individual. Health: is defined as the relatively stable internal functioning of the client. Optimal health exists when the client is maintained in a high state of wellness or stability. Environment: The environment is composed of internal and external forces, or stressors, that produce change or response in the client. Stressors may be helpful or harmful, strong or weak. Nurse: The nurse's role is to identify at what level or in which boundary a disruption in the client's internal stability has taken place and then to aid the client in activities that strengthen or restore the integrity of that particular boundary. ID Stressors: This model is based on the nursing process and identifies three levels of intervention: primary, secondary, and tertiary. - primary: prevention/teaching - secondary: treatment - tertiary: restore client system to balance; offers support after treatment and discharge

Jean Watson model of Human Caring

This model uses a philosophical approach rather than the systems theory approach seen in many other nursing models. Her main concern in the development of this model was to balance the impersonal aspects of nursing care that are found in the technological and scientific aspects of practice with the personal and interpersonal elements of care that grow from a humanistic belief in life. Client: This model views the client as someone who has needs, who grows and develops throughout life, and who eventually reaches a state of internal harmony. Holistic or gestalt view of client; "This model views the client as someone who has needs, who grows and develops throughout life, and who eventually reaches a state of internal harmony." Environment: Viewed primarily as a negative element in the health-care process, the environment consists of those factors that the client must overcome to achieve a state of health. Both external and internal. Health: To be healthy the individual must be in a dynamic state of growth and development that leads to reaching full potential as a human. In this model, the state of illness is not necessarily synonymous with the disease process. If the person reacts to the disease process in such a way as to find meaning, that response is considered to be healthy. Nursing: The process of nursing in this model is based on the systematic use of the scientific problem-solving method for decision-making. To best understand nursing as a science of caring, the nurse should hold certain beliefs and be able to initiate certain caring activities. Values: a humanistic, altruistic system of values based on the tenet that all people are inherently valuable because they are human. Caring: establishing a relationship of help and trust between the nurse and the client; encouraging the client to express both positive and negative feelings with acceptance; manipulating the environment to make it more supportive, protective, or corrective for the client with any type of disease process; and assisting in whatever way is deemed appropriate to meet the basic human needs of the client.

What is a prospective payment system?

This system required facilities providing services to Medicare clients to be reimbursed using a fixed-rate system and included monetary incentives to reduce the length of hospital stays.

Technology

Use of science and the application of scientific principles to any situation; often involves the use of complicated machines and computers. The earliest attempts to define nursing informatics focused solely on the use of technology. A commonly used early definition of nursing informatics stated that it existed whenever the nurse used any type of information technology in delivering nursing care or in the process of educating nursing students.

Aggressive

Whereas assertive communication permits individuals to honestly express their ideas and opinions while respecting the other's rights, ideas, and opinions, aggressive communication strongly asserts the speaker's legitimate rights and opinions with little regard or respect for the rights and opinions of others.

Describe behaviors that are considered uncivil and civil in the clinical setting

Workplace incivility is a broad term that includes workplace hostility, bullying, lateral violence, horizontal violence, vertical violence, and workplace violence. It is the threat of violence or the actual causing of physical harm to workers either inside or outside of the workplace.

Review examples of ways a nursing license may be revoked

• Conviction for a serious crime • Demonstration of gross negligence or unethical conduct in the practice of nursing • Failure to renew a nursing license while still continuing to practice nursing • Use of illegal drugs or alcohol during the provision of care for clients or use that carries over and affects clients' care • Willful violation of the state's nurse practice act

Conflict resolution tips

• Seminars • Books • Mentors

Be familiar with the developmental stages of human spirituality.

• Stage 1: The chaotic (antisocial) stage, with its superficial belief system • Stage 2: The formal (institutional) stage, with its adherence to the law • Stage 3: The skeptic (individual) stage, with its emphasis on rationality, materialism, and humaneness • Stage 4: The mystical (communal) stage, with its "unseen order of things"