Nursing Today: Chapter 1 fundamentals of nursing
Twentieth-First Century
Nursing irganizations are involved to decrease the nursing shortage and acoomodate to todays medical needs and the futures'
Lillian Wald and Mary Brewster
Opened the Henry Street Settlement, focusing on the health needs of the poor in NY who lived intenements in New York City
Informatics
Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.Examples: Navigate an electronic health record. Protectconfidentiality of protected health information in electronic health records.
communicator
central to the nurse-patient relationship; allows you to know your patients, including their strengths, weaknesses, and needsessential to give comfort and emotionalsupport, give care effectively, make decisions with patients and families, protect patients fromthreats to well-being, coordinate and manage patient care, assist patients in rehabilitation, orprovide patient education
Evidenced Based Practice
clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferenceshospitals achieve the Magnet Recognition for excellence in Nursing Practice
four roles APRN
clinical nurse specialist (CNS)certified nurse practicioner (CNP)certified nurse midwife (CNM)certified RN anesthetist (CRNA)
Nurse Researcher
conducts evidence-based practice and research to improve nursing care and further define and expand the scope of nursing practiceat least a masters degree but generally a phd is required
Hospital Compare and Hospital Consumer Assessment of Healthcare
consumer oriented website that allows people to compare performance on spesific areas such as surgery, heart diseases.. and obtain information on hospital care
Nurse Practice Acts
describe and define the legal boundaries of nursing practice within each state
educator
explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient's progress in learningex educate a diabetic patient how to adminster insulinthey would know by teaching to you back
QSEN (Quality and Safety Education for Nurses)
focus on competency needed to continuously improve quality of care in their work environmentPatient centeredTeamwork and CollaborationEvidence-Based PracticeQuality ImprovementSafetyInformatics-Electronic charts
Professional organanizations
for nursing they seek to improve thestandards of practice, expand nursing roles, and foster the welfare of nurses within the specialty areasthey also present educational programs and publish journalsexamples for students are National student Nurses Association
caregiver
help patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process
Certification in nursing
include Minimum practice requirements are set, based on the certification the nurse seeks.National nursing organizations such as the ANA have many types of certification to enhance yourcareer such as certification in medical surgical or geriatric nursing.After passing the initial examination, you maintain your certification by ongoing continuing education and clinical oradministrative practice.
Evidenced Based Practice
integrastes best current evidence with clinical expertise and patient/family preferencesex demonstrate knowledge of basic scientific methodsappreciate strengths and weaks. of scientific bases for practiceregulaly reading relevant journals
Continuing Education
involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutionsit updates your knowledge on the latest reasearcg and practice developments in a particular area if practice, skills, or techniqueex a program to care for older adults with demntia offered by a university
code of ethics
is the philosophical ideals of right and wrong that define the principles you willuse to provide care to your patients. It is important for you to also incorporate your own values andethics into your practice.
nursing
is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations (ANA)encompases autonomous and collarative care of individuals of all ages, families, groups, and communities.... Advocacy, promotion of a safe enviorment, research, participation in shaping health policy and in patient and health system management, and education is also key in this role (ICN)
Quality and Safety Education for Nurses (QSEN)
nitiative to respond to reports about safety and quality patient care by the IOMaddresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environmentsinitiative encompasses the competencies ofpatient-centered care, teamwork and collaboration, evidence-based practice, quality improvement,safety, and informatics
Mother Bickerdyke
organized ambulance services and walked abandoned battlefields at night, looking for wounded soldiers.
In-Service Education
programs are instruction or training provided by a health care agency or institution to increase the knowlege on nursesoften focused on new tech such as how to use new syringes
Contemporary Influences
Importance of nurses' self-careChanges in society lead to changes in nursing:Affordable Care Act (ACA)Rising health care costsDemographic changesMedically underserved
What is autonomy?
Independent nursing interventions that the nurse initiates without medical orders
ICN
International Council of Nurses
What is the purpose of the Nurse Practice Act?
It regulates the scope of nursing practice for the state and protects public health, safety, and welfare
Clara Barton
Launched the American Red Cross in 1881. An "angel" in the Civil War, she treated the wounded in the fieldfounder of the American Red Cross, tended soldiers on the battlefields, cleansing their wounds,meeting their basic needs, and comforting them in death.
twenieth century
Mary Adeling Nutting was the first nursing professor Colombias Teacher College in 1906Army and Navy Nurse Corps were establishedGraduate programs for nirse midwifery programs began
Safety
Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.examples:examine human factorsuse basic safety design principlesown role in preventing errors
Advanced Practice Registered Nurse (APRN)
Most independently functioning nurse; has advanced education in pathophysiology, pharmacology, and physical assessment andcertification and expertise in a specialized area of practiceRequires a master degree in which it emphezises your knowledge in the basic sciences and research-based clinical experience
impact of nursing on politics and health policy
Nurses and their professional organizationslobby for health care legislation to meet the needs of patients, particularly the medically underserved.EX: nurses in communities provide home visits to newborns of high-riskmothers (e.g., adolescent, poorly educated, or medically underserved). These visits result in fewer emergency department visits, fewer newborn infections, fewer developmental delays, and reducedinfant mortality
advocate
protect your patient's human and legal rights and provide assitence in asserting these rights if the need arisesEX: Finding more info on a tratment that a patient is consideringorspeaking out against policies or actions that putpatients in danger or conflict with their rights
Nursing Shortage
shortage affects all aspects of nursing, including patient care, administration, and nursingeducation; but it also represents challenges and opportunities for the professionTime management, therapeuticcommunication, patient education, and compassionate implementation of bedside skills are essential to provide care besides the shortage
Civil War (1860-65) to 20th Century
stimulated growth in the US for nurses
Competent
A nurse who has been in the same clinical position for 2 to 3 years. This nurse55understands the organization and specific care required by the type of patients (e.g., surgical,oncology, or orthopedic patients). He or she is a competent practitioner who is able to anticipatenursing care and establish long-range goals. In this phase the nurse has usually had experiencewith all types of psychomotor skills required by this specific group of patients.
Advanced Beginner
A nurse who has had some level of experience with the situation. Thisexperience may only be observational in nature, but the nurse is able to identify meaningfulaspects or principles of nursing care.
expert
A nurse with diverse experience who has an intuitive grasp of an existing or potentialclinical problem. This nurse is able to zero in on the problem and focus on multiple dimensions ofthe situation. He or she is skilled at identifying both patient-centered problems and problemsrelated to the health care system or perhaps the needs of the novice nurse.
Proficent
A nurse with more than 2 to 3 years of experience in the same clinical position. Thisnurse perceives a patient's clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. Thisnurse focuses on managing care as opposed to managing and performing skills.
What is compassion fatigue?
A state of burnout and secondary traumatic stress
What is an APRN?
Advanced Practice Registered Nurse4 roles:1.) CNM (certified nurse mid-wife)2.) CNP (certified nurse practitioner)3.) CNS (certified nurse specialist)4.) CNRA (certified nurse registered anesthestist)
ANA
American Nurses Association
Certified Nurse-Midwife (CNM)
An APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwifes.a nurse practitioner who handles pregnancy, labor, and delivery and care for thenewborn. It includes some gynecological services such as routine Papanicolaou (Pap) smears,family planning, and treatment for minor vaginal infections.
Professional Responsibilities and Roles of Nursing
Autonomy and AccountabilityCaregiverAdvocateEducatorCommunicatorManager
Florence Nightingale
English nurse remembered for her work during the Crimean War (1820-1910)Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poorsanitation with cholera and dysentery. She volunteered during the Crimean War in 1853 andtraveled the battlefield hospitals at night carrying her lamp; thus she was known as the "lady withthe lamp."provided better sanitary, nutrion and basic facilites and as a result, the mortality rate at the Barracks Hospital in Scutari, Turkey, was reduced from 42.7% to2.2% in 6 monthsshe developed the first organized program for training nurses, the Nightingale Training Schoolfor Nurses at St. Thomas' Hospital in London. 1860
Trends in Nursing
Evidence-based practiceQuality and Safety Education for Nurses (QSEN)Impact of emerging technologiesGenomicsPublic perception of nursingImpact of nursing on politics and health policy
Educator
Explains concepts and facts about health, describes the reason for activities, demonstrates, reinforces, and evaluated the patients' progress in learning.
Nursing as a profession
Extended educationUnique body of knowledgeProvides a specific serviceHas autonomy***Provides quality patient centered care in a safe conscientious and knowledgeable manner (presence)
What is a caregiver?
Helps the patient maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence
Demographic Changes
The US Census Bereau predicts increase in population there for the health care resources must expand to acommodate to its health needs.
What is the Standards of Professional Performance? (ANA)
1.) Ethics2.) Advocacy3.) Respectful and equitable practice4.) Communication5.) Collaboration6.) Leadership7.) Education8.) Scholarly inquiry9.) Quality of practice10.) Professional practice evaluation11.) Resource stewardship12.) Environmental health
What is nursing?
The diagnosis and treatment of the human response, advocacy, protection, promotion and optimization of health and abilities.
Who was Mary Mahoney?
The first professionally trained African American nurse
Who was Clara Barton?
The founder of the American Red Cross
Standars of Nursing Practice ANA
1. Assessment2. Diagnosis3.Outcome Identification4.Planning5.Implementation6.Evaluationstated by the ANA
What are the five levels of proficiency, according to Benner?
1.) Novice: no experience and learning a specific set of rules2.) Advanced Beginner: some experience3.) Competent: has the same clinical position for 2-3 years and can anticipate the type of care that will be needed4.) Proficient: more than 2-3 years of experience at the same clinical setting5.) Expert: has diverse experience
what are the competencies of QSEN initiatives?
1.) Patient-centered care2.) Teamwork and collaboration3.) EBP4.) Quality Improvement5.) Safety6.) Informatics
Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples? (Select all that apply.)1. Caregiver2. Autonomy and accountability3. Patient advocate4. Health promotion5. Lobbyist
1. Caregiver2. Autonomy and accountability3. Patient advocate4. Health promotionEach of these roles includes activities for the professional nurse. Each of these is used in direct care or is part of professionalism that guides nursing practice. Some nurses are lobbyists, but being a lobbyist is not expected of all professional nurses.
Standards of Professional Performance (ANA)
1. Ethics: The registered nurse practices ethically.2. Education: The registered nurse attains knowledge and competency that reflects current nursingpractice.3. Evidence-Based Practice and Research: The registered nurse integrates evidence and researchfindings into practice.4. Quality of Practice: The registered nurse contributes to quality nursing practice.5. Communication: The registered nurse communicates effectively in all areas of practice.6. Leadership: The registered nurse demonstrates leadership in the professional practice setting andthe profession.7. Collaboration: The registered nurse collaborates with health care consumer, family, and others inthe conduct of nursing practice.8. Professional Practice Evaluation: The registered nurse evaluates her or his own nursing practicein relation to professional practice standards and guidelines, relevant statutes, rules, andregulations.9. Resources: The registered nurse uses appropriate resources to plan and provide nursing servicesthat are safe, effective, and financially responsible.10. Environmental Health: The registered nurse practices in anenvironmentally safe and healthy manner.nurses must follow this to meet thet standards of high quality patient care
Advanced practice registered nurses generally:1. Function independently2. Function as unit directors3. Work in acute care settings4. Work in the university setting
1. Function independentlyAdvanced practice registered nurse functions independently as a clinician, educator, case manager, consultant, and researcher within his or her area of practice to plan or improve the quality of nursing care for the patient and family.
Health care reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform?1. Moving from an acute illness to a health promotion, illness prevention model2. Moving from illness prevention to a health promotion model3. Moving from an acute illness to a disease management model4. Moving from a chronic care to an illness prevention model
1. Moving from an acute illness to a health promotion, illness prevention modelHealth care reform also affects how health care is delivered. There is greater emphasis on health promotion, disease prevention, and management of illness.
What external nursing forces affected the nursing practice in the 21st century?
1.) Aging population2.) Cultural diversity3.) Bioterrorism4.) Emerging infections5.) Disaster management
What is the ANA (American Nurses Association) Standards of Nursing Practice?
1.) Assessment2.) Diagnosis3.) Outcome identification4.) Planning5.) Implementation6.) Evaluation(ADPIE!)
A critical care nurse is using a computerized decision support system to correctly position her ventilated patients to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency?1. Patient-centered care2. Safety3. Teamwork and collaboration4. Informatics
4. InformaticsUsing decision support systems is one example of using and gaining competency in informatics.
A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with the family. The nurse is acting as the patient's:1. Educator2. Advocate3. Caregiver4. Case manager
2. AdvocateAn advocate protects the patient's human and legal right to make choices about his or her care. An advocate may also provide additional information to help a patient decide whether or not to accept a treatment or find an interpreter to help family members communicate their concerns.
Which of the following nursing roles may have prescriptive authority in their practice? (Select all that apply.)1. Critical care nurse2. Nurse practitioner3. Certified clinical nurse specialist4. Charge nurse
2. Nurse practitionerNurse practitioners and certified clinical nurse specialists encompass the role and preparation of the advanced practice registered nurse. According to the American Nurses Association standards of practice, prescriptive authority may be granted to these nurses
A nurse is caring for an older-adult couple in a community-based assisted living facility. During the family assessment he notes that the couple has many expired medications and multiple medications for their respective chronic illnesses. They note that they go to two different health care providers. The nurse begins to work with the couple to determine what they know about their medications and helps them decide on one care provider rather than two. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency?1. Patient-centered care2. Safety3. Teamwork and collaboration4. Informatics
2. SafetyHelping the patients understand the consequences and complications of multiple medications helps to build the competency in safety.
Evidence-based practice is defined as:1. Nursing care based on tradition2. Scholarly inquiry of nursing and biomedical research literature3. A problem-solving approach that integrates best current evidence with clinical practice4. Quality nursing care provided in an efficient and economically sound manner
3. A problem-solving approach that integrates best current evidence with clinical practiceEvidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, auscultates her lung sounds, listens to her heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed?1. Diagnosis2. Evaluation3. Assessment4. Implementation
3. AssessmentAssessment is the collection of comprehensive data pertinent to the patient's health and/or the situation.
Nurses at a community hospital are in an education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education?1. Continuing education2. Graduate education3. In-service education4. Professional Registered Nurse Education
3. In-service educationIn-service education programs are instruction or training provided by a health care agency or institution. An in-service program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution.
You are participating in a clinical care coordination conference for a patient with terminal cancer. You talk with your colleagues about using the nursing code of ethics for professional registered nurses to guide care decisions. A nonnursing colleague asks about this code. Which of the following statements best describes this code?1. Improves self-health care2. Protects the patient's confidentiality3. Ensures identical care to all patients4. Defines the principles of right and wrong to provide patient care
4. Defines the principles of right and wrong to provide patient careWhen giving care, it is essential to provide a specified service according to standards of practice and to follow a code of ethics. The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care for your patients. The code serves as a guide for carrying out nursing responsibilities to provide quality nursing care and the ethical obligations of the profession.
A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed?1. Planning2. Evaluation3. Assessment4. Implementation
4. ImplementationImplementation is completing coordinating care and the prescribed plan of care.
The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career?1. Clinical nurse specialist2. Nurse administrator3. Nurse educator4. Nurse researcher
4. Nurse researcherThe nurse researcher investigates problems to improve nursing care and to further define and expand the scope of nursing practice. He or she often works in an academic setting, hospital, or independent professional or community service agency.
The examination for registered nurse licensure is exactly the same in every state in the United States. This examination:1. Guarantees safe nursing care for all patients2. Ensures standard nursing care for all patients3. Ensures that honest and ethical care is provided4. Provides a minimal standard of knowledge for a registered nurse in practice
4. Provides a minimal standard of knowledge for a registered nurse in practiceRegistered nurse (RN) candidates must pass the NCLEX-RN® that the individual State Boards of Nursing administer. Regardless of educational preparation, the examination for RN licensure is exactly the same in every state in the United States. This provides a standardized minimum knowledge base for nurses.
What is a nursing administrator?
A nurse that manages patient care and the delivery of specific nursing services within a health care agency
What is a nurse educator?
A nurse that work primarily in schools and nursing, staff development, departments of health care agencies, and patient education departments.
Autonomy and Accountability
Autonomy refers to the ability to act according to one's knowledge and judgment, providing nursing care within the full scope of practice as defined by existing professional, regulatory, and organizational rulesAutonomy involves the initiation of independent nursing interventions without medical ordersEX:For example, you independently implementcoughing and deep-breathing exercises for a patient who recently had surgery. As you continue tocare for this patient, a complication arises. You note that the patient has a fever and the surgicalwound has a yellow-green discharge. You collaborate with other health professionals to develop thebest treatment plan for this patient's surgical wound infection. With increased autonomy comesgreater responsibility and accountability.Accountability means that you are responsible, professionally and legally for the type and quality of nursing care provided.
Benner's stages of nursing proficiency
Because as a nurse you are requiered to have current knowlegdge and practical standardsnovice, advanced beginner, competent, proficient, expert
novice
Beginning nursing student or any nurse entering a situation in which there is no previouslevel of experience (e.g., an experienced operating room nurse chooses to now practice in homehealth). The learner learns via a specific set of rules or procedures, which are usually stepwiseand linear
manager
Coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency.uses appropriate leadership styles to create a nursing environment for patientsand staff that reflects the mission and values of the health care organization
Mary Mahoney
First professionally trained African American nurseShe was concerned with the effect culture had on health care, and as a noted nursingleader she brought forth an awareness of cultural diversity and respect for the individual,regardless of background, race, color, or religion.
Teamwork and Collaboration
Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.ex recognize the contribution of each health team member and familydiscuss effective strategies for communicating and conflict solvingparticipate in designing methods to support effective teamwork
A nurse is working with a young childbearing family who has one child with a congenital heart disease. The parents are trying to determine the risks of a second child being born with congenital heart disease.Describe why genomics information is important in assisting the parents in this decision.
Genomics can help identify possible genetic defects that the parents may pass on to their children.
What is an advocate?
Protects patients' human and legal rights and provides assistance in asserting these rights.
Career Development in Nursing
Provider of Care, Advanced Practice Registered Nurses, Nurse Educator, Nurse Administrator, Nurse Researcher, nurse risk manager, quality improvement nurses, consultants, or business owners
Certified RN Anesthetist (CRNA)
Provides surgical anesthesia under the the guidence of an anesthesiologist
patient centered care
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.It includes listening to, informing and involving patients in their care. Health care programs that focus on patients provide care that is respectful of individual preferences and responsive to personal needs and valueex:involve fam and friends in careelicit patient preferencesprovide care with respect for diversity
medically underserved
Rising rates of unemployment, underemployment, and low-paying jobs, mental illness, and homelessthis affects the ability to care and provide and pay for these services
Who was Mary Adelaide Nutting?
She was instrumental in moving nursing education into universities
What is the Code of Ethics?
Statement of philosophical values of right and wrong that define the principle you will use to provide care to patients.
What does a Nurse Practitioner do?
The provide comprehensive health care to a group of patients in an inpatient, outpatient, ambulatory care or community based setting
What does a CRNA do?
The provide surgical anesthesia.
Diagnosis
The registered nurse analyzes the assessment data to determine the diagnoses orissues.EX:The nurse looks over John's symptoms and notes that his heart-rate is higher than average and his blood pressure is elevated. She also considers that he's experienced fatigue and shortness of breath before when his cholesterol levels were very high.
Assesment
The registered nurse collects comprehensive data pertinent to the patient's healthand/or the situation.EX John visits his general physician on Monday because he was feeling sick over the weekend. When he is called back from the waiting room, the nurse on staff takes his temperature, heart rate, and blood pressure. She then asks John a series of questions about how he's been feeling lately. The nurse notes his responses when he says he's been having difficulty breathing and has been feeling very tired. She also sees on John's medical history that he has had previous problems with his cholesterol levels and blood pressure. John also has a blood sample taken during his doctor's visit.
Evaluation
The registered nurse evaluates progress toward attainment of outcomes.EX: When John returns, the nurse asks him a series of questions about how he's been feeling. John replies that he has been having an easier time breathing and feels significantly less tired since exercising and taking the medication. The nurse marks "Patient's Condition Improved" on his official medical records and congratulates John on his well being. She then advises him to remain on the medication for one more month and to continue his exercise.
Implementation
The registered nurse implements the identified plan.5a. Coordination of Care: The registered nurse coordinates caredelivery.5b. Health Teaching and Health Promotion: The registered nurse usesstrategies to promote health and a safe environment.5c. Consultation: The graduate level-prepared specialty nurseadvanced practice registered nurse provides consultation toinfluence the identified plan, enhance the abilities of others, andeffect change.5d. Prescriptive Authority and Treatment: The advanced practiceregistered nurse uses prescriptive authority, procedures, referrals,treatment, and therapies in accordance with state and federal lawsand regulations.EX:John is prescribed the medication and takes it as recommended. One week later, he has a day where he feels especially sick and calls the doctor's office. The nurse explains that the medication could cause nausea as a side-effect and advises John to drink Ginger-Ale and avoid any foods that generally upset his stomach. John continues taking the medication and goes to the gym four times during the two week period. Once the two weeks has passed, he returns to the doctor's office for his follow-up appointment.
What is genomics?
The study of all the genes in a person and the interaction of the genes with one another and the persons environment
What is a communicator?
They are essential for all nursing roles and activities.
What is a nurse researcher?
They conduct EBP and research to improve nursing care and to expand the scope of nursing practice
Who is a nursing manager?
They have personnel, policy, and budgetary responsibility for a specific nursing unit
Who was Lillian Wald and Mary Brewster?
They opened the Henry Street Settlement that focused on the needs of the poor
What does a Certified Nurse-Midwife do?
They provide the independent care for women in normal pregnancy, labor and delivery, and care of newborns.
Health care advocacy groups recognize the importance of the role quality professional nursing has on the nations' health care.One such program is the Robert Wood Johnson Foundation (RWJF) Future of Nursing: Campaign for Action.
This program is a multifaceted campaign to transform health care through nursing, and it is a response to the Institute of Medicine (IOM) publication on The Future of Nursing (IOM, 2010).Together these initiatives prepare a professional workforce to meet health promotion, illness prevention, and complex care needs of the population in a changing health care system.
Quality Improvement
Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.Examples:Use tools such as flow charts and diagrams to make process of care explicit. Appreciate how unwanted variation in outcomes affects care. Identify gapsbetween local and best practices.
Importance of Nurses' Self-Care
You cannot give fully engaged, compassionate care to others when you feel depleted or do not feel cared for yourself.Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue.Being a professional includes caring for yourself physically and emotionally.To avoid the extremes of becoming overly involved in patients' suffering or detaching from them, nurses develop self-care strategies to maintain balance.
provider of care
a healthcare staff member who provides care to patientsa nurse can be a provider in a acute setting but it can also be in the communitythe goal is to relieve and educate the patient so they could return home
How did Nightingale see the role of a nurse?
a nurse is in charge of somebody's health with the knowledge of how the body recovers from the disease
The Affordable care act
affects how health care is paid for and delivered (see Chapter 2). There will be greateremphasis on health promotion, disease prevention, and illness management in the future.impacts how and where nursing care is provided. More nursing services will be in community-based care settings. As a result, more nurses will be needed to practice in community care centers,schools, and senior centers.
nurse practicioner (NP)
an APRN is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans.
Clinical Nurse Specialist (CNS)
an APRN who is an expert clinician in a specialized area of practiceEX: The specialty may be identified by a population (e.g., geriatrics), a setting (e.g.,critical care), a disease specialty (e.g., diabetes), a type of care (e.g., rehabilitation), or a type ofproblem (e.g., pain)
Genomics
describes the study of all the genes in a person and interactions of these genes with one another and with that person's environmentusing genomics info allows health providers to determine giw genomic changes contribute to patient condition and influences treatment decisionexample: a person with colon cancer before the age of 50, gives the chance that other family member may also have the risk of colon cancer before 50, therefore a colonoscopy must be performed due to higher riskit is a nurse duty to identify risk factors through assesment and counceling patients about what genomic finding means to thema nd their fam.
Nurse Practice Acts
laws established in each state in the US to regulate the practice of nursingThey expanded their scope to include minimum educationrequirements, required certifications, and practice guidelines for APRNs such as nurse practitionersand certified RN anesthetists. The expansion of scope of practice includes skills unique to theadvanced practice role (e.g., advanced assessment, prescriptive authority for certain medicationsand diagnostic procedures, and some invasive procedures).
Nurse Administrator
manages patient care and the delivery of specific nursing services within a health care agency
Nursing Graduate Education
masters emphazies advanced knowledge in basic sciences and research based clinical practice important for nurse educators, nurse administrator and is required for an APRNdoctoral preparation, phd, prepare nurses for more rigorous research and theory development and award the research oriented Doctor of philosophy in nursing
Licensure in Nursing
require for all candidates to pass the NCLEX RN, provides a standarixed minimum knowledgeother requirements like criminical bacground vary from state to tsate
planning
the RN develops a plan that prescribes strategies and alternatives to attain expected outcomesEX: John returns on Tuesday for a follow-up visit. The nurse sits down with him in a closed room and explains his cholesterol levels and high blood pressure. She suggests that John be put on medication to help lower these numbers and recommends he exercise at least twice a week. The nurse also tells John he should stay away from salty foods and eat less red meat. John agrees with the nurse, and they setup a follow-up appointment two weeks later. The nurse reminds John to call if there are any changes in his condition, or if he starts to feel worse.
Outcome Identification
the RN identifies expected outcomes for a plan individualized to the patient or situationEX:The nurse determines that John is experiencing Hyperlipidemia, also known as having high levels of fat within the blood. John's blood tests confirm this hypothesis. The nurse is also concerned that John is at risk for heart disease.
HarrietTubman
was active in the Underground Railroad movement and helped to lead over 300 slaves tofreedom
nurse educator
works primarily in schools of nursing, staff development departments of health care agencies, and patient education departmentsA nurse, usually with an advanced degree, who teaches in educational or clinical settings; teaches theoretical knowledge and clinical skills; conducts research must have a lot of clinical exoerience and usually have one specialization
