Nursing Exam 2

Skills for informatics

*Seek education on use of informatics *Navigate electronic health records *Use this to monitor outcomes of care

Attitudes for evidence based practice

*Value the need for research for quality improvement *Value importance of reading new research *Value the need for keeping current

Continuing competency

"Continuing competence is the ongoing commitment of a registered nurse to integrate and apply the knowledge, skills and judgment with the attitudes, values and beliefs required to practice safely, effectively and ethically in a designated role and setting."

Knowledge and comprehension

(<10%) - recalling specific facts and understand them in relationship to a pathophysiological condition. Knowledge of specific anatomy and physiology Medication dosage and side effects Signs and symptoms of diseases Laboratory test results Elements of certain treatments and interventions.

What are skills for collaboration and teamwork?

*Act w/ integrity and respect for others *Function competently w/in scope of practice *Communicate w/ team members *Provide safe handoffs among providers

Attitudes for quality improvement

*Appreciate continuous QI is essential part of daily work *Value measurement and its role in good patient care *Appreciate how individuals can improve care

What are attitudes for collaboration and teamwork?

*Appreciate importance of intra and inter-professional collaboration * Value the expertise of all heath team members *Value teamwork

Attitudes for informatics

*Appreciate the necessity for nurses to maintain lifelong learning of info technology *Value technology in stopping patient errors *Protect confidentiality of health info and records

Skills for safety

*Demonstrate strategies that reduce risk of harm to self and others *Communicate concerns related to pt safety *Use national pt safety goals in care settings Use appropriate strategies for reducing reliance on memory (such as, forcing functions and checklists) Use organizational error reporting systems for near miss and error reporting Engage in root cause analysis rather than blaming when errors or near misses occur

Knowledge for quality improvement

*Describe ways for learning about outcomes of care *Understand nursing students are part of care that affect patient outcome *Understand measurement of assessing quality of care

What is knowledge for collaboration and teamwork?

*Describe your function within health team *Know Your scope of practice *Understand various communication style and preferences *Know impact of team functioning for patient safety

Knowledge for safety

*Examine human and organizational practices that lead to unsafe practices *Describe benefits and limitations of safety enhancing technologies *Describe national safety goals, initiatives, and regulations Discuss effective strategies for reducing reliance on memory Describe processes used in understanding causes of error and allocation of responsibility (such as, root cause analysis)

Knowledge for informatics

*Explain why info and tech skills are needed for safe pt care *Know info needed to support safe pt care *Understand diff technology and its uses in clinical areas

Skills for quality improvement

*Get info on quality improvement tools used in the care setting *Use this info to improve care *Identify gaps b/w current practice and best practice

Knowledge for evidence based practice

*Have basic knowledge of scientific methods and processes *Know diff b/w clinical opinion and research summary *Explain the role of evidence in determining best clinical practice

Skills for evidence based practice

*Participate in data collection *Base care plans on EBP *Read research related to practice *Question rationale for routine approaches to care

Physiological integrity

43 to 67% Basic care and comfort Pharmacological and parenteral therapies Reduction of risk potential Physiological adaptation Pediatrics to gerontology

Code of ethics for nursing

Functions as a general guide for the profession's members and as a social contract with the public that it serves

When do we address a "safety issue"?

As soon as we see it

What is patient safety?

Decreased risk of harm by individual actions or system design.

Attitudes for safety

*Value your own role in preventing errors  *Value monitoring needs *Value a relationship b/w national safety goals and practice settings Appreciate the cognitive and physical limits of human performance Value own role in preventing errors Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care team

Advanced Nursing practice

-Advanced nursing practice builds on the competencies of the registered nurse and is characterized by the integration and application of a broad range of theoretical and evidence-based knowledge that occurs as part of graduate nursing education. -Advanced Practice Registered Nurse (APRNs) ---Master's or doctoral degrees in nursing, are certified in their designated specialty practice areas, and are recognized and approved to practice in their roles by state boards of nursing or other regulatory oversight bodies, often through special professional licensing processes. ---APRNs are educationally prepared in one of the four APRN roles (certified nurse practitioners, certified registered nurse anesthetists, certified nurse-midwives, and clinical nurse specialists) and in at least one of six possible population foci: family/individual across the life span; adult/gerontology; neonatal; pediatrics; women's health/gender-related health; psychiatric/mental health). APRN specialty practice may focus on specific populations beyond those identified or focus on healthcare needs (such as oncology, palliative care, substance abuse, nephrology) that meet criteria for specialization as identified in the APRN Consensus Model.

How can RNs use the social policy statement?

-As a framework for understanding professional nursing's relationship with society and its obligation to those who receive professional nursing care -creates expectations and outcomes for both the nurse and the patient, protecting the nurse and is legally binding -helps to establish trust -helps to avoid miscommunication -Public policy and the healthcare delivery system influence the health and well-being of society and professional nursing. Individual responsibility and interprofessional involvement are essential.

Standards of professional nursing practice

-Authoritative statements by which the profession describes the responsibilities for which its practitioners are accountable. -Reflect the values and priorities of the profession and direction for professional practice and framework to evaluation of this practice.

LPN job responsibilities

-Care for people who are sick, injured, convalescent, or disabled under the direction of physicians and registered nurses. -they provide basic bedside care -prepare and give injections and enemas, monitor catheters, dress wounds, and give alcohol rubs and massages -supervise nursing assistants and aides. -Most LPNs are generalists and will work in any area of healthcare

Certification and credentialing

-Certification and credentialing are both recognition systems that identify whether nurses meet certain requirements or standards -Credentialing is typically required -Certification may be voluntary To obtain either certification and credentialing-nurses must first be licensed

Doctoral programs

-Doctor of philosophy (PhD) - most accepted academic degree and is designed to prepare individuals to conduct research. -Doctor of education (EdD) - focuses more on administration in the educational setting. -Doctor of Nursing Practice (DNP) - provides leadership for evidence-based practice -A new degree designed to replace the masters degree for nurses who which to practice in advanced roles such as NP or Nurse Midwives. Doctor of Nursing Science (DNSc or DSN) - a clinically oriented nursing degree-an emphasis on clinical research -Fewer than 2% of nurses.

Associate degree programs

2-year program offered through community colleges or as options at four-year universities. Graduate receives Associate Degree in Nursing (ADN). Program stresses basic skill preparation with clinical practice occurring increasingly in community-based institutions (e.g. ambulatory settings, schools and clinics). Such programs contribute 60% of nurse graduates.

The test plan

Client needs Level of cognitive ability Integrated concepts and processes Nursing process Caring Communication Cultural awareness Documentation Self-care Teaching learning

Health promotion and maitenance

6 to 12% Life span growth and development Prevention and early detection of disease Includes: birth control, obstetrics, newborn care, contagious diseases (STD)

Nursing Social Policy Statement

Components: Social Context of Nursing Nursing Definition Knowledge Base for Nursing Practice Scope of Nursing Practice Standards of Professional Nursing Practice Regulation of Professional Nursing Application of the Statement

Pew report recommendations

Expanding the scientific basis of the programs Promoting interdisciplinary education Developing cultural sensitivity Establishing new alliances with managed care companies and government Increasing the use of computer technology and interactive software.

Competency

Expected level of performance that integrates knowledge, skills, abilities, and judgment

Nurse Licensure Compact (NLC)New model for license portability

Allow nurses to practice and communicate with patients across state lines without obtaining an additional license. States must enter into an NLC (Nurse License Compact) in order to achieve mutual recognition. * National Council of State Boards of Nursing (NCSBN) website

QSEN

Quality and safety education in nursing

Accreditation of nursing programs

Accreditation: process whereby an organization recognizes a program of study having met predetermined qualifications and standards. Voluntary Helps in guiding the school according to recommendation and criteria. Agency sets criteria.

Who is responsible for patient safety?

All of us

Synthesis, judgment, evaluation

Asks you to process information on more than one fact Apply rules, methods, principles or theories to a situation and make judgments and decisions about patient care. Often more than one correct answer.... Asks you to prioritize, evaluate the effectiveness of care, most appropriate nursing action to take. Best indication of critical thinking ability and provide safe care.

Aims of higher education programs

Baccalaureate = generalist Master's = specialist Doctorate = researcher and leadership

Early practical nursing schools

Ballard School. Opened in 1892 in New York City by the YMCA. Thompson Practical Nursing School. Established 1907 in Brattleboro, Vermont. Still operating today. Household Nursing School. Founded in 1918 in Boston

Autonomy

Capacity of a nurse to determine his or her own actions through independent choice within the full scope of nursing practice

Challenges to nursing education

Decreasing employment of nurses in acute care settings. Need to practice with self-reliance, independence and flexibility. Well-developed decision-making skills on the basis of critical thinking ability. High-quality client education delivery while working within the constraints of managed care and cost constraints.

Evolution of baccalaureate education

During the late 1940s and early 1950s, awareness began to develop that there was a need to stratify nursing education programs into technical levels and professional levels. It became apparent that all health-care professionals should have, at minimum, a baccalaureate education.

Nursing Education: LP/VNs

Education is focused on basic nursing skills and direct client care. Educated in community colleges, hospitals, vocational programs.

Social Context of nursing

Elements: Humans manifest an essential unity of mind, body and spirit. Human experience is contextually and culturally defined. Health and illness are human experiences. The relationship between the nurse and patient occurs within the values and beliefs of the patient and the nurse.

Professional regulation

Establishing and maintaining a professional code of ethics➻Determining standards of practice➻Fostering the development of nursing theory, derived from nursing research➻Establishing nursing practice built on a base of best evidence➻Establishing the specifications for the educational requirements for entry into professional practice at basic and advanced levels➻Developing certification processes as measures of professional competence

Knowledge

Examine common barriers to active involvement of patients in their own health care process Describe strategies to empower patients or families in all aspects of the health care process *Inform, communicate, and educate *Understand how diverse cultural, ethic, and social backgrounds function as patients, family, and a community *Demonstrate understanding of pain and suffering *Understand how safety and cost effectiveness is improved through patient involvement

Advanced practice

Expanded role or expanded practice. Nurse practitioners Pediatrics, neonatal, geriatric, ob-gyn, family, psychiatric, rehabilitation. Certified registered nurse anesthetist Nurse midwife Have prescriptive authority Able to function without physician oversight and supervision. More collaborative

Before the nursing profession what groups filled the role of nurses?

Family members, the military, religious orders, & self trained individuals

The Future of Nursing report recommendation

Increase the proportion of RNs with baccalaureate degrees to 80% by 2010 Goal has not yet been reached though there has been improvement As of 2014, 55% of registered nurses hold a BSN

Foreign Nursing Graduates

International Centre for Nurse Migration provides resources for nurses who are moving from one country to another All internationally educated nurses must pass the NCLEX exam, comply with standards of approved or comparable education, hold a verified valid and unencumbered state license, and be proficient in their written and spoken English language skills -* A nurse who is interested in practicing internationally may contact the International Council of Nurses or the nursing regulatory board of the country in which he or she wishes to practice. Graduates of Foreign Nursing Schools is an organization that ensures that nurses educated in countries other than the United States are qualified to meet licensure and other practice requirements in the United States. A license is required to practice nursing in all countries. A cultural assessment test is not required prior to licensure.

Collaboration is...

Joint decision making among independent parties Involving joint ownership of decisions Collective responsibility for outcomes Working across professional boundaries

Components

Knowledge Skills Attitude

Brown Report 1948

Led to the accreditation program for nursing schools, which was conducted by the NLN Accreditation is a process of reviewing what a school is doing and its curriculum based on established standards

Legal regulation

Legal regulation is the oversight, monitoring, and control of designated professionals, based on applicable statutes and regulations, accompanied by the interpretation of these laws. All nurses are legally accountable for actions taken in the course of professional nursing practice, as well as for actions delegated by the nurse to others assisting in provision of nursing care. Such accountability is accomplished through legal regulatory mechanisms of licensure; granting of authority to practice, such as nurse practice acts; and criminal and civil laws.

Licensure by endorsement

Licensure by endorsement refers to the original program whereby nurses who are licensed in one state seek licensure in another state without repeat examination.

Decrease in diploma schools

Many programs transitioned to degree programs and that has caused a decreased in diploma schools of nursing

NCLEX

National Council Licensure Examination Indicates minimal level of knowledge or competency deemed necessary by the state to practice nursing without injury to clients Legal requirement for all professions that deal with public health, welfare, or safety. Computerized, criterion-referenced exam. Compares your knowledge to a pre-established standard. Measures nursing knowledge of a wide range of material

Characteristics of diploma schools

No academic degree Source of free, inexpensive labor Learning on the job Minimal classroom or theoretical study. Became expensive since a change in criteria decreased the shift requirements. During the 1960s and 70s many programs converted to degree granting schools. Emphasis on preparing technically competent clinical nurses with some elements of leadership, humanities, and general sciences.

Nursing actions

Nursing Actions The aims of nursing actions-protect, promote, and optimize health; prevent illness and injury; alleviate suffering; and advocate for individuals, families, communities, and populations. Nursing actions are theoretically derived, evidence-based, and require well developed intellectual competencies.

Team members

Nursing Assistant (may be certified) Practical (vocational) nurse Hospital-based diploma nurse 2-year associate degree nurse Baccalaureate nurse

Integrated concepts and processes

Nursing process Concepts of caring Therapeutic communication Cultural awareness Documentation Self-care Teaching and learning

What is the purpose of the social policy statement?

Nursing's Social Policy Statement expresses the social contract between society and the profession of nursing Helps nurses engage in the political and legislative action that supports nursing education, research, and practice to better influence health care The social policy statement of our profession is about the multiple ways in which nursing helps others through direct patient care, & by changing institutions, society and global health

Evidence based practice

Old - Adhere to internal policies and procedures. New - Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

Patient/family centered care

Old - Listen to patient and demonstrate compassion and respect. New - Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values and needs

Quality improvement

Old - Update nursing policies and procedures, chart audits of documentation. New - Use data to monitor outcomes of care processes and improvement methods to design and test changes to continuously improve quality and safety of health care systems

Collaboration and Teamwork

Old - Work side by side with other HC professionals while performing nursing skills. New - Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care

Safety

Old - focus on individual performance, vigilance to keep patients safe. New - Minimize risk of harm to patients and providers through both system effectiveness and individual performance

Informatics

Old - timely and accurate documentation New - Use information and technology to communicate, manage knowledge, mitigate error, and support decision-making

Simulation experiences

One way nursing schools are overcoming the barrier to decreased clinical settings are utilizing simulation experiences to provide opportunities students would get in the clinical setting

Competencies

Patient/Family Centered Care Teamwork and Collaboration Safety Evidence-based Practice Quality Improvement Informatics

Entry into practice

Pew Commission (1995) Multiple entry point to professional nursing practice is one of nursing's strengths. Nurse must distinguish between the practice responsibilities of the graduates of each of the different educational environments.

Application and analysis

Presume you have the basic information and then ask you to analyze, interpret and apply information to specific situations. Requires the ability to separate information into its basic parts, decide what is important and make a decision. Application requires you to use that information in client care decisions.

Credentialing=qualifications to practice

Process that ensures practitioners such as RNs are qualified to perform as demonstrated by having licensure Used by healthcare organizations to check for licensure of healthcare professionals and to monitor continued licensure Current license needs to be showed to current employer Every state provides access to online checks of licensure status Education, certification, and maintenance of malpractice insurance may also be reviewed Goal is to protect the public by ensuring that specific state requirements are met

Purpose of QSEN

Purpose: to prepare nurses with the competencies necessary to continuously improve the quality and safety of the health care systems in which they work -Funded by RWJ Foundation PI: Linda Cronenwett, PhD, RN, FAAN -Investigators for Phase 1: Jane Barnsteiner, Joanne Disch, Jean Johnson, Pam Mitchell, Dory Sullivan, Judith Warren

Skills

Remove barriers to presence of families and other designated surrogates based on patient preferences Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management *Elicit patient values and preferences and implement care plans reflecting this *Assess presence and extent of pain and suffering and begin treatment to relieve *Communicate all care provided

Attitudes

Respect patient preferences for degree of active engagement in care process Respect patient's right to access to personal health records * Respect and value patients preferences and needs *Value the patients expertise w/ their health and symptoms *Value partnership b/w nurse and patient

Master's degrees programs

Restricted to RNs who have baccalaureate degree, many requiring experience. 36 to 48 college credits. Specialized areas of study: Nursing administration, community health, psychiatric mental health, adult health, maternal-child health, gerontology, rehabilitation care, nursing education. Advanced practice areas: anesthesiology, nurse practitioners, clinical nurse specialists

Client health needs

Safe and effective care environment Physiological integrity Psychosocial integrity Health promotion and maintenance needs Makes up between 21-33% of questions Overt safety issues Use of restraints Medication administration Infection prevention Isolation precautions

Accreditation Process

Schools are assessed for: Mission and vision Structure and governance Resources and physical facilities Faculty Curriculum Student support services Admissions process Policies and procedures Ongoing assessment process

Knowledge base for nursing practice

Science Philosophy Ethics Biology Psychology Technology Social science Economic and organizational theory Physical science -Nurses use their theoretical and evidence-based knowledge of these human experiences and responses to collaborate with patients and others to assess, diagnose, plan, implement, evaluate care, and identify outcomes. Nursing interventions aim to produce beneficial effects, contribute to quality outcomes, and—above all—do no harm. Nurses use the process that is evidence-based practice as a foundation of quality patient care to evaluate the effectiveness of care in relationship to identified outcomes.

Self Regulation

Self-regulation, which requires personal accountability for the knowledge base for professional practice, is an individual's demonstrated personal control based on principles, guidelines, and rules deemed important. Nurses develop and maintain current knowledge, skills, and abilities through formal academic programs and continuing education professional development programs. When available, nurses pursue certification in their area of practice to demonstrate this competence.

What was the 1st school of nursing, when & where did it open & who opened it?

St. Thomas in London, England in the year 1860 by Florence Nightingale -Training school and those that quickly followed also became a source of cheap labor for hospitals Students were provided with some formal nursing education, but they also worked long hours in the hospitals and were the largest staff source During the same era, similar programs opened in the United States These programs were called diploma or hospital schools of nursing Quality of schools varied widely because there were no standards aside from what the individual hospital wanted to do. Overtime some of these schools formed partnerships with universities so that students could receive some content through an academic institution Despite the small efforts to improve, the schools continued to be very different from one another, and there were concerns about the lack of standardized quality nursing education

Nursing Assistant

Takes a course and a certification exam. Responsibilities: Basic nursing skills - changing beds linens, vital signs, bathing patients, helping them eat walk and exercise, maintaining a safe environment. Some hospitals educate the assistants to take blood samples, blood sugars and obtain urine samples.

What does a new graduate need to know and be able to do?

Teaching clients health promotion and prevention. Teaching clients about how lifestyle affects health. Effective supervision of less educated staff. Effective delegation and monitoring of staff. Efficient organization of routine daily tasks. Safe administration of medications. Competence in use of computer databases and charting. Ability to organize care for 6 to 10 clients at the same time.

It is not patient focused care when...

That is when the patient/family may be involved, but the health care provider retains control over decision-making, patient needs and preferences may or may not be sought, and rarely drive care decisions.

Nursing Education Changes

The Goldmark Report: Published in 1923, this report concluded that for nursing to be on an equal footing with other disciplines, nursing education should occur in the university setting. Institute of Research and Science in Nursing Education Report: Resulted in the establishment of practical nursing under Title III of the Health Amendment Act of 1955. This led to a growth in practical nursing schools in the U.S.

Nursing compact licenses

The Nurse Licensure Compact is an agreement that allows multistate nursing licensure for registered nurses (RNs) and licensed practical nurses (LPNs) in an efficient manner Nurses who do not live in a compact state will not be permitted to have multistate licensure unless they obtain licenses for each state in which they would like to practice

National Council Licensure ExaminationNCLEX-RN

The exam is a computerized adaptive test-computer adjusts questions to the individual candidate -exam is highly individualized Exam includes a variety types of questions such as multiple-response, fill-in-the-blank, and hot spot items using a picture or graphic Passing scores are the same for every state and are set by the NCSBN-Varies year to year Can re-take Results within 4 weeks and are pass/fail and no specific scores are revealed First time pass rate reviewed routinely & must be reported to school accreditation org Can be put on probation by their state BONs if pass rates are a problem

Key message of QSEN

The patient and family are in a partnered relationship with their health care providers and are equipped with relevant information, resources, access and support to fully engage in and/or direct the health care experience as they choose. Improving patient care requires a systematic process of defining problems in order to identify potential causes and develop strategies to improve care. The process requires the ability to measure care. We can only improve if we measure how well we are doing and compare our performance against others.

Lack of nursing faculty leads to fewer new nurses entering the profession

The shortage of nursing school faculty is limiting the number of students able to attend nursing school Causes: Aging population of faculty, reducing hiring of younger faculty, lack of faculty/ clinical sites and inadequate education budget.

What is your responsibility?

Timely, accurate data collection Timely, complete documentation No falsification of information. It is up to you to keep patient data "clear and concise" so you don't muddy the water.

Goals of QSEN

To alter nursing's professional 'identity' so that when we think of what it means to be a respected nurse, we think not only of caring, knowledge, honesty and integrity.... But also, that it means that we value, possess, and collectively support the development of quality and safety competencies

Diploma Programs

Typically 3 years in length and offered by hospitals. Graduates receive diploma rather than a college degree. Program emphasizes basic skills particularly suited for hospital clients. Such programs contribute 6% of nurse graduates.

Baccalaureate Degree Programs

Typically 4 years in length, offered through colleges and universities. Graduate receives Bachelor of Science in Nursing (BSN) Emphasizes preparation for practice in nonhospital settings, broader scientific content, and systematic problem-solving tools for autonomous and collaborative practice. Such programs contribute 34% of all nursing graduates.

Q's

When was the 1st training school of nursing opened in the US? 1872 What was the famous trio of nurse schools in the US in 1872? The Bellevue Hospital N.Y The New England Hospital for women & children in New Haven C.T. Massachusetts general Hospital in Boston In 1873 who became the 1st trained nurse educated in the USA? Melinda Anne Richards (Linda) Who was the 1st nursing Professor? Mary Adelaide Nutting in 1907 from the school known as "Mother House" What school opened the 1st Nursing school separate from the university department that had its own budget & dean? The Yale School of Nursing in 1924 Who was the dean at Yale's School of Nursing? Anne W. Goodrich

"Practical Nursing"

Women who cared for others, but who had no formal education, often called themselves "practical nurses."

Bloom's Taxonomy

classification of six levels of intellectual behavior important in learning. They are hierarchical in nature, meaning that students must master the content at each of the lower levels before moving to the next highest level. Six Levels Of Bloom's Taxonomy 1. Remembering (lowest level)2. Understanding3. Applying4. Analyzing5. Evaluating6. Creating (highest level)

Clinical nurse specialist

focuses on a specific patient population. A CNS can specialize in certain types of diseases (such as diabetes or cardiovascular disease), can work in many different medical environments (such as operating room, emergency room or critical care), and can focus on a variety of procedures (such as surgical or clinical).