Prof. Nurs. final
Philosophy
- a set of beliefs about the nature of how things work and how the world of nursing should be viewed. i. Nursing philosophy ties together the concepts of nursing's Metaparadigm.
Hazel Johnson-Brown
- first African American woman to be Brigadier General, chief of the army nurse corps.
Florence Nightingale
- founded the first training school for nurses at St. Thomas hospital in London. Also did publications for hospital reform and her most famous publication is What It Is and What It Is Not.
Theory
- group of related concepts, definitions, and statements that describe a certain view of nursing phenomena (observable occurrences) from which to describe, explain or predict outcomes
Conceptual model or framework
- is an organizational structure that makes clearer connections between concepts.
Mary Eliza Mahoney
- the first African American professionally educated nurse.
Metaparadigm
- the most abstract aspect of the structure of nursing knowledge. i. Consists of the major concepts of the discipline: person, environment, health, and nursing (and caring has recently been added)
What are the four core values of LSON?
-Caring -Diversity -Integrity -Leadership
What can each nurse do to improve the public's image of the profession?
-Nurses should act professionally with every patient -Nurses should reinforce positive images of nursing and speak out.
Rehabilitation and long-term care
-Rehabilitation Centers help restore the patient to the fullest possible level of function and independence following injury or illness. -Long-term care is provided in residential facilities such as assisted-living homes, skilled and intermediate nursing homes, and personal care homes. Each facility is tailored to provide services that the patient or family cannot provide, but at levels that maintain the individual's independence as long as possible.
Review the 4 page pdf document that is posted on eCourseware entitled "The Future of Nursing" IOM Report Brief. Know the 4 recommendations of this report.
1) Nurses should practice to the full extent of their education and training 2) Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression 3) Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. 4) Effective workforce planning and policy making require better data collection and an improved information infrastructure (EBP)
Reflective practice
A method of focusing on one's practice, both in the moment and after an event, with an open and curious mind, drawing on all the senses to know one- self more fully.
What was the Affordable Care Act designed to achieve?
Affordability accessible good quality
What is the "nursing process"?
Assess; Diagnosing; Planning; Implementing; Evaluating
What are national nursing associations and organizations recommending as the basic educational preparation for entry into nursing?
BSN
Which degree are you earning?
BSN
4 categories of APNs.
Certified nurse practitioner (CNP) Clinical Nurse Specialist (CNS) Certified nurse-midwife (CNM) Certified Registered Nurse Anesthetist (CRNA)
Know the primary focus and "overarching goals" of Healthy People 2020 (see Figure 14-1, page 285).
Healthy People 2020 is a national program focused on health promotion and disease prevention for the US Population. Overarching Goals: • Attain high quality, longer lives free of preventable disease, disability, injury, and premature death • Achieve health equity, eliminate disparities, and improve the health of all groups • Create social and physical environments that promote good health for all • Promote quality of life, healthy development and healthy behaviors across all life stages
Are most nurses members of the American Nurses' Association?
NO!
CH 15 Review each of the Key Points on page 330.
Professional associations are the bridge between the profession and politics. Through these organizations nurses have the opportunity to help in changing policies for the profession. It is difficult choosing which associations to be apart of, therefore do research and ask yourself key questions to decide which one is right for you. Being politically active is important and can be as simple as voting.
What is the QSEN project? What is it designed to do?
Quality and Safety Education for Nurses (QSEN) Prepare future nurses to continuously improve the quality and safety of health care systems
What must a nurse do to engage in personal reflection?
Serve as a mirror to the patient by directing patient questions back to the patient, encouraging patients to think through problems for themselves
Why were the first nursing schools in the United States established?
TO STAFF HOSPITALS a. Established in 1872, located at Bellevue Hospital in New York, The New England Hospital for Women and Children in New Haven, Connecticut, and Massachusetts General Hospital in Boston.
Nonmaleficence:
The duty to inflict no harm or evil.
Licensure
The process by which an agency of government grants permission to qualified persons to engage in a given profession or occupation.
Veracity:
Truthfulness
CH 14 Review each of the Key Points on page 310.
a. Health care agencies have traditionally been structured with boards of directors, CEOs, medical and nursing staffs, and members of a variety of other disciplines. b. Accreditation and continuous quality improvement efforts are to ensure public safety and institutional effectiveness and accountability. c. There are health disparities among our population, and is a disadvantage to the poor and minorities. Correcting this is hard, and there has only been a little progress. d. Nurses have a variety of roles: provider of care, teacher, manager, researcher, collaborator, and patient advocate. e. Attempts to manage costs have forced major changes in the health care delivery system f. Medicare and Medicaid programs have been a serious financial drain on federal and state budgets, and even with cost-containment efforts put in in the 1970s, health care costs have continued to increase. g. Nurses play a role in managing health care costs by becoming more cost aware, efficient, and effective. h. The Affordable Care Act is a start in improving access to affordable health care coverage for all American citizens; however, mechanisms to implement of all or portions of the act are yet to be determined.
What is a "third party payment"?
a. Health insurance created an indirect payment structure known as third-party payment that removed price sensitivity from the concern of most health care consumers because they only pay a small portion of the actual cost. The third party pays the rest. A third party could be the employer, insurance company, or government.
Know the basics of Nightingale's philosophy of nursing.
a. Health is the major concern of nursing, whereas illness is the focus of the physician. b. She stressed the importance of observing the patient and accurately recording health information c. She believed that health was related to patients' environments. i. Clean water and environment, adequate ventilation, balanced diet, etc. d. She recognized nursing's role in protecting patients. i. Shielding from harm, not discussing upsetting news, not tiring a patient e. She promoted sensitivity to the effect of the environment, which was the foundational work for the theory that changing patients' environments could positively affect their health. i. A nurse who would open the blinds to help the patient see sunlight and teach a patient about eating a balanced diet
Review the knowledge and use of nursing theory at the four levels of nursing education (see Box 13-5, page 281).
a. PhD: i. Conduct theory testing and theory development research, frames practice, administration, or research in nursing work b. DNP or MSN: i. Frames advanced practice w/ nursing model or theory, uses theory to guide research with practice questions c. BSN: i. Uses models, theories, and middle-range theories to guide nursing practice d. ADN: i. May be introduced to middle-range theories for nursing practice
CH 13 Review each of the Key Points on page 282.
a. Theory development is an activity that combines education, knowledge, and skill b. Nursing philosophies, models and theories offer many perspectives on nursing with different levels of abstraction c. Theories must be peer reviewed before publishing d. Early theorists used clinical expertise to guide theory's e. Nursing's Metaparadigm: person, environment, health, environment, and nursing bg f. Nurses in practice settings have invaluable insight and observations and contribute to the body of knowledge
Know the 3 essential elements of any successful health care system - quality, access, affordability (or reasonable cost).
a. There are two main means to ensure maintenance of quality standards. i. Accreditation of health care agencies takes place through one of two accrediting bodies approved by the Centers for Medicare and Medicaid Services (CMS) 1. The Joint Commission is a nonprofit serving as the nation's predominant standard-setting and accrediting body in health care. 2. Healthcare Facilities Accreditation Program (HFAP) ii. Continuous quality improvement/total quality management 1. An internal strategy for organizations to work toward improvement in patient outcomes 2. Use employees from different departments to decide how care will be provided, what outcomes are desired, and design appropriate systems 3. Focus on establishing procedures for ensuring high-quality patient care b. Access i. United States and South Africa are the only two industrialized nations that do not provide universal access to health care to all citizens. ii. U.S. health expenditures far exceed those of any other country in the world. The U.S. infant death rate is ranked 44 of 224. iii. Despite widespread public support for reform, the efforts have been very difficult to achieve. c. Affordability i. President Obama signed Affordable Care Act (ACA). 1. It includes comprehensive reforms to improve access and protect consumers from abusive insurance company practices. 2. It is unlikely that a systematic and comprehensive reform of the entire health care system is possible. a. Instead, we can expect state-by-state efforts to address issues. 3. Most experts agree that reform efforts must be designed to reduce OR not increase cost of health care in order to be supported by Congress. 4. General questions should be asked to evaluate reform proposals.
Know the basics of Roy's adaption model.
a. Widely used today and investigates patients' biopsychosocial adaptive systems or their coping abilities within their environment. i. "How can I modify this patient's environment to facilitate his or her adaptation?" b. When the demands of the environment (stressors) are too high or person's adaptive responses (coping behaviors) are too low, the patient's behavioral responses are ineffective. c. Nurses assess the environmental stimuli of both internal and external environments. d. Then, nurses assess a patient's adaptive behavior that results from the stimuli. e. Nurses next develop nursing diagnoses as a result. i. These guide goal-setting and interventions aimed at promoting adaptation. f. Nurses modify the environment to facilitate patient adaptation
Justice:
an ethical principle stating that equals should be treated the same and that non-equals should be treated differently.
Primary care services
i. Care rendered at the point at which a patient first enters the health care system ii. Care provided in physician's office or various clinic settings
Government agencies (public)
i. Federal agencies focus on the health of all U.S. citizens; promote and conduct health and illness research; provide funding to train health care workers; assist communities in planning health care services; develop, staff, and help fund health programs 1. Examples: National Institute of health, US Dep't of Health and Human Services, the Occupational Safety and Health Administration, the Centers for Medicare and Medicaid Services, and Centers for Disease Control and Prevention
For-profit agencies
i. Include numerous home health care companies, hospital systems, specialty outpatient centers, heart hospitals, and rehabilitation centers ii. These agencies distribute profits earned to partners or shareholders. iii. Examples: national nursing home networks, specialty outpatient centers for ambulatory surgery, heart hospitals, and rehabilitation centers.
Sub acute care services
i. Inpatient care that lies between hospital care and long-term care ii. Goal-oriented, comprehensive inpatient care for patients who have acute illnesses, injuries, or exacerbations of a disease process iii. Provides lower-cost health care than alternatives
Secondary care services
i. Involve the prevention of complications from disease ii. Include treatment of temporary dysfunctions requiring medical intervention or hospitalization not available in primary care settings iii. Can be provided by home health agencies, ambulatory care agencies, skilled nursing agencies, and surgical centers iv. Recent addition is disease management programs.
Tertiary care services
i. Provided to acutely ill or injured patients, those requiring long-term care or rehabilitation services, and for the terminally ill ii. Can be a hospital trauma center, burn center, or pediatric hospital, long term-care facilities, rehabilitation centers, or through hospice services
Not-for-profit agencies
i. Use profits to pay personnel, improve services, advertise services, provide educational programs, or otherwise contribute to the mission of the agency
Voluntary agencies (private) and nongovernment organizations (NGOs)
i. Work to promote or restore health through private donations and government grants ii. Example: American Heart Association, American Cancer Society, American Red Cross, March of Dimes iii. An NGO is an association of citizens, independent of government, with goal of delivering resources.
What are the 4 concepts of the nursing Metaparadigm?
person, environment, health, and nursing
Know the difference between policy and politics.
• "Politics" is the science of government; regulation and governing of a nation or state and/or the management of a political party; the conduct and contest of parties with reference to political measures or administration of public affairs • Policy is a plan or course of action by a government, political party, or business intended to affect and determine decisions, actions, and other matters. • Policy frequently is shaped by those who are successful in politics, such as elected officials.
What are the benefits of belonging to a professional nursing organization?
• Developing leadership skills • Certification • Continuing education • Political activism • Opportunities to define practice standards, take positions on practice issues, and develop ethical guidelines • Opportunities to engage in research projects • Opportunities for networking with peers • Group-sponsored services for individual nurses - Access to journals, jobs, newsletters; travel discounts; products; professional liability insurance programs; group health insurance programs
Diagnosis and treatment
• Diagnosis and treatment -Traditional goal of medicine; assess symptoms, conduct diagnostic tests, generate formal diagnoses, plan and implement treatment regimens -Modern technology allows for refined diagnostic methods. -Examples include PET and CT scans to follow the size and location of solid tumor cancers, then basing treatment off of their findings.
Health promotion
• Health promotion and maintenance services assist patients to remain healthy, prevent diseases and injuries, detect diseases early, and promote healthier lifestyles. o Examples include health education programs (e.g., prenatal classes), exercise programs, health fairs, wellness programs (worksite/school), and nutrition education.
illness prevention
• With the increasing ability to identify risk factors, such as a family history of disease and genetic predispositions, illness prevention services are now better able to assist patients in reducing the impact of those risk factors on their health and well-being. They address health problems after risk factors are identified, whereas health promotion services seek to prevent development of risk factors. o Examples of illness prevention includes community health programs, promotion of healthy lifestyles to counteract risk factors, occupational safety programs (e.g., use of eye protection for work that endangers the eyes), environmental safety programs (e.g., proper disposal of hazardous waste), and legislation that prevents injury or disease (e.g., seat belt/child restraint laws, motorcycle helmet laws).
What internal and external factors have contributed to the shortage of nurses in the past?
-The inadequate supply of nurse prompted Congress to budget for nursing education -Other job offers -the intensity of nursing has increased over the years - not enough educators -low salaries -stressful long hours
Clara Barton
- founded American Red Cross. Appealed to the nation for supplies of woolen shirts, blankets, towels... "Angel of the battle field".
Dorothea Dix
- union superintendent of women nurses. Champion for mental health and created training program for women who wanted to serve.
What does the acronym PICOT stand for?
a. P - Population of interest b. I - Intervention of interest c. C - Comparison of interest d. O - Outcome e. T - Time
What can be the consequences of a professional boundary violation?
a. Offense reportable to your employer and or your BON and violates the nursing's code of ethics.
Are you born with the ability to think critically, or can it be learned?
Learned
Autonomy:
Self-determination. Control over one's own professional practice.
Beneficence:
The ethical principle of doing good.
Continuing Education (CE):
Workshops, conferences and short courses in which nurses maintain competence during their professional careers.
Accreditation:
a voluntary review process of educational programs or service agencies by professional organizations i. Supplementary, voluntary review ii. All nursing programs require approval by SBN iii. Promotes adherence to standards that protect quality of edu, protect public safety and protect the nursing profession 1. 2 bodies: a. Commission on Collegiate Nursing Edu. (CCNE)- BSN and MSN, LSON b. National League for Nursing Accreditation Commission (NLNAC)- all programs iv. To qualify for federal funds and to have students take NCLEX, must graduate from accredited university
Know what "self-efficacy" is and how it relates to promoting health and changing lifestyle behaviors.
a. "Perceived self-efficacy": High belief in one's self-efficacy leads to efforts to change, whereas low perceived self-efficacy leads to a fatalistic lack of change. b. help people take charge of their own health-related behaviors c. Patient's health beliefs are powerful assets for/or obstacles to the ability to foster his or her own health. d. Change is often very slow.
Know what a system is and be able to give some examples of systems
a. A system is a set of interrelated parts b. The parts form a meaningful whole c. The whole (Nursing) is different from and greater than the sum of the parts d. Systems may be open or closed e. All living systems are open systems f. Systems strive for internal stability (homeostasis) g. Systems are part of suprasystems h. Systems have subsystems i. A change in one part of system creates change in other parts j. Examples of systems: i. Hospital ii. Department of nursing iii. A particular unit iv. With a colleague group
What is the process of "professional socialization"?
a. Absorbing and assimilating the culture of nursing: rites, rituals and ruled behavior
Know how to resolve conflicts in inter-professional situations.
a. Acknowledge the conflict b. Recognize and affirm that positives can result from conflict c. Facilitate debate over task issues while redirecting concerns away from the personal level d. Promote expression of varying perspectives e. As conflict is worked through, explore alternative positions taking opportunities to synthesize several ideas to create a new position f. Be willing to change your position on an issue g. Share power: elicit everyone's opinions and look for win-win situations h. Stay focused on the desired out come (Basically keep an open mind and be open to change while keeping outcome in mind)
Know the characteristics of an acute and a chronic illness.
a. Acute: i. Severe symptoms ii. Relatively short in duration iii. Appear suddenly, progress steadily, reside quickly iv. Pt may or may not need medical attention v. Complications may lead to chronic illness vi. May represent a life crisis b. Chronic: i. Gradual onset of symptoms ii. Symptoms mild or vague iii. Requires on-going medical treatment iv. May continue duration of pt's life v. Have significant social and economic impact on pt vi. Remission and exacerbation vii. Often represents a life crisis
What is reality shock? I won't ask you to know the different stages of it.
a. Conflicts of ideals with reality in the workplace Ex: nursing shortages, difficulty working conditions, nursing staff turnover, older more chronically ill patients, absence of positive reinforcement, lack of frequent communication.
Know the characteristics of a critical thinker.
a. Critical thinking in nursing is purposeful, informed, out-come focused thinking that is guided by standards, policies, ethics codes and laws b. Based on principles of nursing process, problem-solving, and the scientific method c. Focuses on safety and quality d. Carefully identifies the key problems, issues and risks involved e. Applied logic, intuition and creativity f. Raise questions/problems and express them clearly and precisely g. Gather and assess related info h. Arrive at conclusions and solutions that are well reasoned and evaluate them i. Stay open-minded and see alternative ways of seeing the problem j. Communicated effectively about solutions to complex problems k. RED i. Recognize assumptions ii. Evaluate arguments iii. Draw conclusions
CH 8 Review each of the Key Points on page 167.
a. Critical thinking is a skill that can be learned. In nursing it is a purposeful, disciplined, active process that improves clinical judgment and thereby improves patient care b. The nursing process is a systematic problem-solving framework that ensures that care is developed in an organized, analytical way c. The phases of the nursing process are assessment, analysis and diagnosis, planning, implementation and evaluation d. Properly used the nursing process if cyclic and dynamic rather than rigid and linear e. Nurses may initially fine that using it feels awkward or slow, with experience most find it becomes a natural, organized approach to patient care f. Consistent, comprehensive and coordinated patient care results when nurses use the nursing process effectively g. Both the scientific basis of nursing and professionalism are advanced when nurses resolve patient problems through the use of the nursing process h. Sound clinical judgment is created by using critical thinking, applying the nursing process, staying current with developments, understanding your scope of practice and acquiring substantial clinical experience.
Know the sequence of the establishment of the diploma, associate degree and BSN programs (first, next, most recent).
a. Diploma program: 24 month, hospital based b. Associate Degree in Nursing (ADN) program: 2 year, most common c. Bachelor's of Science in Nursing (BSN) program: 4 years, accredited University d. DNP most recent
Know the common causes of communication breakdowns and be prepared to recognize an example of each.
a. Failing to see the uniqueness of the individual: caused by preconceived ideas, prejudices, stereotypes i. "My back is really hurting today. I can hardly turn over in bed." ii. "I guess we have to expect these little problems when we get older." b. Failure to recognize levels of meaning: must learn to respond to symbolic communication that lies under overt meaning i. P: "It's getting awfully warm in here." ii. N: "I'll adjust the air conditioning for you." (Not seeing deeper meaning) 1. Should say: "Perhaps there is something about our convo that is making you uncomfortable." c. Using value statements and clichés: indicates nurse has made a judgment from own framework without considering that patient may feel different i. P: "My mother is coming to see me today." ii. N: "How nice. There's nothing more comforting as a mother's love." 1. Should say: "How are you feeling about her visit?" d. Giving false reassurance: only temporary support, delegitimizes patient concerns i. P: "I'm so afraid the biopsy will show cancer." ii. N: "Don't worry. You have the best doctor in town. Besides, cancer treatment is really good these days." 1. Should say: "I regret that you are having to go through this. Let's talk about your concerns." e. Failure to clarify: lead to confusion and misinterpretation i. P: "I've got to get out of the hospital. They have found out I'm here and may come after me." ii. N: "No one will harm you here." 1. Should say: "Who are 'they' Mrs. Johnson?"
Know the four criteria or elements of successful communication
a. Feedback: when receiver relays to sender the effect of the message. b. Appropriateness: a reply fits the circumstances and matches message c. Efficiency: speakers uses simple, clear words that are timed at pace suitable for listener d. Flexibility: speaker bases messages on immediate situation rather than preconceived expectations
What are examples of informal and formal socialization experiences in nursing and nursing school?
a. Formal: class lectures, assignments, lab experiences, new vocab b. Informal: lessons that occur incidentally; Unplanned observations, participating in SNA, hearing nurses discuss patient care.
CH 11 Review each of the Key Points on page 238.
a. Goal of nursing research is improving nursing care through EBP b. Research in laboratory(bench research) or at the bedside(clinical research) c. Nurses of all educational backgrounds are consumers of research and have a role in carrying it out d. Nursing research is defined as the systematic investigation of phenomena of interest to nursing with a goal of patient care improvement
Describe the concept of "health". Know the World Health Organization's definition of health.
a. Health is the third major concept fundamental to the practice of professional nursing. b. Neither health nor illness is an absolute state; rather, both are best viewed as continuums c. The nursing profession embraces a holistic view of health, incorporating all aspects of a person, not just physical ones d. World Health Organization (WHO; 1947): i. Health is "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."
CH 10 Review each of the Key Points on page 218.
a. Illness is highly personal and reactions vary by culture b. Previous ill experience play a role in how a person will behave c. Pt's spirituality often play a role in stress reduction d. Nurses must provide holistic care e. Caring is the emotional cornerstone of professional nursing practice f. Changing one member of a family will change all other members
What is spiritual distress?
a. Impaired ability to experience and integrate meaning and purpose in life through with self, others, art, music, literature, nature, and/or a power greater than one's self
How do nurses develop sound clinical judgment?
a. Informed opinions and decisions based on empirical knowledge and expertise b. Best means for developing clinical judgment is to gain extensive direct patient care contact c. Requires you to i. Recall facts ii. Recognize patterns iii. Form a meaningful whole iv. Know your limits v. Act appropriately
What is Peplau's theory of "therapeutic use of self"?
a. Interpersonal terms, reinforcing the idea of the patient as a collaborator in their care b. TUS: strategy that you can develop with practice. Can be helpful to you in relating effectively to patient's, families and other health care professionals. Part of interpersonal relations in nursing
Know the behaviors of an effective communicator (slide and pages 179-184).
a. Listen well b. Convey empathy c. Ask open-ended questions d. Use reflection e. Communication meaningfully with silence: periods of quiet thought during interaction without feeling pressure to fill f. Communicate across differing languages with interpreters g. Think critically: interpret, analyze, make inferences, evaluate, explain rationale, self-examine personal communication skills
CH 6 Review each of the Key Points on page 129.
a. Nursing has been difficult to define, although it is crucial to delineate nursing from other health care professions. b. Definitions of nursing reviewed in this chapter have more in common than they have differences c. The dynamic nature of nursing, society and health care will likely prevent the development of one standard definition of nursing d. Socialization is a critical process in which novices become well-functioning professional nurses. e. Socialization occurs in two ways: through education and the workplace. f. Individuals have the responsibility to participate actively in their own professional socialization by seeking out experiences that enhance socialization. g. Reality shock is a stressful period that new nurses may experience when entering nursing practice. Understanding the stages of reality shock and how to resolve them can assist new grads through this transition h. Mentors can be valuable resources in enhancing and enriching the professional socialization experience. i. Self-care is very important so that you are better prepared to take care of others.
CH 12 Review each of the Key Points on page 263.
a. Persons can be viewed as open systems who are motivated by needs b. Health is a dynamic and viewed as a continuum c. Nurses view health holistically d. Health is affected by health beliefs and behaviors e. Nurses need to be aware of their beliefs and values to prevent them from intruding in their care f. The purpose of developing a philosophy of nursing is to shape and guide nursing practice
Review Maslow's Hierarchy of Needs. Identify the most basic (lowest) and highest level of needs.
a. Physiological needs, safety needs, social needs, esteem needs, self-actualization b. The most basic are needs for things necessary for physical survival i. Level 1: those needs that ensure physiologic survival ii. Oxygen, rest, activity, shelter, and sexual expression c. The need for self-actualization is at the highest level of needs. i. Level 5: self-actualization ii. Realization of one's maximum or optimal potential
Be able to determine if a situation is a violation of professional boundaries.
a. Professional boundaries: the spaces between the nurse's power and the client's vulnerability. The power of the nurse comes from the professional position and the access to private knowledge about the client. b. Violations occur when there is confusion between the needs of the nurse and those of the client i. Under-involvement and over-involvement ii. Monitor by asking "can I tell a colleague about this?" c. Signs of Professional Boundary Violations i. Excessive self-disclosure (info about self) ii. Secretive behavior iii. Super nurse behavior- no one is good enough to care for patient but me iv. Singled out patient treatment/inappropriate time with patient v. Selective communication vi. Flirtatious behavior vii. You and me against the world viii. Failure to protect patient- fail to recognize feelings of attraction
What do you do in a professional or clinical situation if your personal morals and values conflict with professional ethics? Which must override the other? (see page 90)
a. Professional ethics must override. It is important to have a clear understanding of your morals and values so that when a conflict like this happens you can make a decision regarding practice setting so that your own personal integrity remains intact while putting the patient and their needs first.
CH 5 Review each of the Key Points on page 110.
a. Professional ethics override personal ethics in professional settings b. Terms "morals" and "ethics" are often used interchangeably but morals reflect what is done in a situation and ethics are concerned with what should be done. Values are beliefs, ideals, and attitudes that one uses to guide behavior c. Being familiar with ethical theories and principles, moral development, and decision-making models prepares nurses to participate actively in resolving ethical dilemmas that occur frequently in health care settings. Two major theorists in moral development are: Kohlberg: Stages of moral reasoning • Preconventional- child and criminal, early moral reasoning • Conventional- most common sense of right and wrong • Postconventional- rare, committed to morals, destructive Gilligans: stages of moral reasoning • Recognize women relationships and men justice d. Codes of ethics developed by profession's members, are important to develop the profession e. The ANA's Code of Ethics for Nurses is nonnegotiable for nurses regarding ethical behavior f. The history of the Code of Ethics for Nurses reflects nursing history as a profession g. Ethical dilemmas occur in all areas of nursing practice h. Respect for humans is the foundation for the six ethical principles of Autonomy, Beneficence, Nonmaleficence, Fidelity, Veracity, and Justice i. Nurses must protect patient's privacy and confidentiality at all times when using social media j. Use of technology in health care institutions has compounded common ethical dilemmas and created new ones for health care workers. k. Dilemmas often occur because of conflicts between personal value systems, patients, families, health care professionals, institutions and society l. Ethical decision-making models are helpful in determining the best action to take when faced with an ethical dilemma.
As a BSN graduate, what will you be expected to do in the area of nursing research?
a. Read, interpret, and evaluate research for applicability to nursing practice b. Identify nursing problems that need to be investigated c. Participate in implementation of studies by assisting senior researchers in data collection d. Disseminate research-based knowledge by sharing useful findings with colleagues
Review the attitudes, beliefs and behaviors that facilitate interprofessional collaboration (Box 9-8, page 190).
a. Respect for other collaborators b. Confidence in own knowledge c. Willingness to learn d. Cooperative spirit e. Belief in a common purpose f. Value contributions of other disciplines g. Willingness to negotiate h. Excellent communication skills i. Self-awareness j. Tolerance of differing opinions k. Not threatened by conflict l. Knowledge of own limits
What does the nurse have to consider in providing culturally competent care?
a. Services that are respectful of and responsive to the health beliefs and practices and cultural and linguistic needs of diverse patient populations b. Without cultural competence as nurse can face these problems: i. Stereotyping 1. "pigeon-holing" patients from different cultures with prior assumptions about their beliefs or behaviors ii. Communication difficulties 1. Patterns of communication are strongly influenced by culture. iii. Misperceptions about personal space 1. Cultures differ in the amount of personal space that is comfortable for members. 2. Nurses must be sensitive to expectations about touch and personal distance. iv. Differing values and role expectations 1. Patients' values and role expectations about nurses, physicians, and themselves may conflict with nurses' values. 2. Nurses need to understand cultural values and role expectations as well as the patient's individual values and role expectations. v. Ethno pharmacologic considerations 1. People of different ethnic groups respond differently to medications. 2. Nurses need to be knowledgeable about ethnic sensitivities to pharmaceutical agents. vi. Ethnocentrism 1. Defined as the inclination to view one's own cultural group as the standard by which to judge the value of other cultural groups 2. Nurses need to identify the ways personal beliefs and expectations can influence care, thereby recognizing and eliminating prejudices.
Know key behaviors in each stage of Benner's Stages of Nursing Proficiency. I will describe a nurse's behavior and ask you to decide which stage (I-V) the nurse is in.
a. Stage 1: Novice: at least 1 year out of school; little background and limited practical skills, relies on rules and expectations of others for direction b. Stage 2: Advanced beginner: 1-2 years out, has marginally competent skills, uses theory and principles much of the time, experiences difficulty establishing priorities c. Stage 3: competent practitioner: 2-3 years, feels competent, organized, plans and sets goals, thinks abstractly and analytically, coordinates several tasks simultaneously d. Stage 4: Proficient practitioner: 3-5 years, views patient's holistically, recognizes subtle changes, sets priorities with ease, focuses on long-term goals e. Stage 5: expert Practitioner: 5 or more years, performs fluidly, grasps patient needs automatically, responses are integrated, and expertise comes naturally.
Know key behaviors in each stage of Cohen's Model of Student Socialization.
a. Stage 1: Unilateral dependence: reliant on external authority. Limited questioning ability or critical analysis. At this stage, simply told what to do b. Stage 2: Negativity/independence: Cognitive rebellion, diminished reliance on external authority. "Why do I have to learn this? What does this have to do with nursing?" c. Stage 3: Dependence/mutuality: reasoned appraisal, begins integration of facts and opinions following objective testing. Evaluate the ideas of others. Begin to appreciate the nursing process as a way to organize care. d. Stage 4: Interdependence: collaborative decision-making, commitment to professional role. Self-concept now includes professional role identity. Highly self-directed and seek out learning experiences to maximize knowledge before entering the real world.
Review the steps of adjusting to an illness and be able to recognize a patient example of each-these stages are descriptive and pt's do NOT move through these in a linear pattern
a. Stage 1: disbelief and denial: i. Defense mechanism used to avoid anxiety and fear ii. Belief that symptoms will just go away iii. May avoid treatment or attempt inappropriate self-treatment b. Stage 2: irritability and anger: i. Emotions r/t alteration of functioning caused by illness ii. Anger may be directed inward or towards others c. Stage 3: attempting to gain control: i. Fears stimulate treatment seeking behavior to gain control over the illness ii. Fear can also lead to further denial and avoidance d. Stage 4: depression and grief: i. Common mood resulting from altered lifestyle, modification of activities, diminished sense of wellbeing, and pain ii. Should be encouraged to seek help and mental health care iii. Grief- normal and expected response to loss including one's health iv. Depression- treatable mental condition e. Stage 5: acceptance and participation: i. Pt acknowledged reality of the illness ii. Pt ready to participate in decisions about treatment
Seven Steps of Evidence-Based Practice
a. Step 0: cultivate a spirit of inquiry b. Step 1: ask clinical questions in PICOT form c. Step 2: search for the best evidence d. Step 3: critically appraise the evidence e. Step 4: integrate the evidence with clinical expertise and patient preferences and values f. Step 5: evaluate the outcomes of the practice decisions or changes based on evidence g. Step 6: disseminate EBP results
What are the ways that a new nurse can effectively deal with reality shock?
a. Take responsibility for getting support from family, friends and co-workers b. Talk to other new grads c. Find a mentor d. Learn more about the profession e. Blogs, forums, and websites f. Care about yourself- strive for balance
How will APNs be used in the future as we attempt to address the crisis in health care?
as primary care providers
CH 9 Review each of the Key Points on page 192.
a. The "therapeutic use of self" means using one's personality and communication skills effectively while implementing the nursing process to help patient improve health status b. Phases in traditional nurse-patient relationship include orientation, working and termination phases. Short term patient contacts in today's streamlined care delivery also present opportunities for connection and goal achievement c. In long-term nurse patient relationship, each phase has specific tasks that should be accomplished before progressing d. Accept others values, beliefs and lifestyles e. Develop awareness of biases can help to prevent intrusion into relationships f. Professional nurses are aware of the boundaries of the therapeutic relationship and strive to stay within the "zone of helpfulness" always g. Communication is the core of all relationships and is the primary instrument though with desired change is effected in others h. Communication is both verbal and nonverbal and consists of a sender, receiver, message, feedback and content i. Perception, evaluation and transmission are the three major operations in communication j. Communication develops sequentially beginning somatic language to action language to verbal language k. Unsuccessful communication is caused by a variety of factors that can be identified and corrected l. Professional medical interpreters are your best resource in providing patients who speak a second language m. The same excellent communication skills that nurses use with patients should be used to collaborate effectively with other professionals n. Professional nurses must be sensitive to sociocultural factors such as age, ethnicity, and gender that can affect communication and collaboration.
CH 7 Review each of the Key Points on page 149.
a. The development of nursing edu has been influenced by a number of factors, leading to a diverse array of program offerings b. First provided in hospitals, entry-level nursing edu has evolved into 3 major types of basic programs: diploma, ADN and BSN, each with has a range of features c. Alt. such as bachelor's degree programs for RNs, eternal degree programs, accelerated options for post bachelor students, and online programs contribute to a rich, yet complex edu picture for RNs d. Voluntary accreditation is designed to ensure the quality of nursing edu programs e. Schools have found it necessary to restrict enrollments because of faculty shortages, lack of clinical sites and budget constraints f. Lifelong learning thru CE is considered essential for all professionals, particularly in practice-based disciplines such as nursing g. The problem of reduced resources in nursing edu may soon reach crisis proportions and weaker schools may close, results of underfunding of higher edu in general and diminishing sources of federal and state funding for schools of nursing h. Graduate programs in nursing are not preparing adequate numbers of nursing educators to meet current and future needs. Faculty shortages are already developing and a severe faculty shortage is expected nationwide in the next decade i. In response to changes in higher edu and the health care system, national orgs have suggested initiatives to revise educational requirements and program emphasis for the twenty-first century that will enable future RNs at all levels to meet the changing health care needs of society. j. QSEN was developed to meet the challenge of ensuring competencies of nursing graduates in patient-centered care, teamwork and collaboration, EBP, quality improvement and informatics.
Know the definitions of (and difference between) the terms values, morals, ethics, and a Code of Ethics.
a. Values: attitudes, ideals or beliefs that guide behavior b. Morals: established rules of conduct to be used to distinguish right from wrong c. Ethics: actions that specify what actions an individual should take d. Code of Ethics: social contract thru which profession informs society of rules guiding f(x)
In order to think like a nurse who is a critical thinker, what are the questions that you would ask yourself?
a. What assumptions have I made about the patient? b. How do I know my assumptions are accurate? c. Do I need any additional information? d. How might I look at this situation differently?
What are manifestations or symptoms of compassion fatigue?
a. When others' needs take too great a priority b. loss of physical energy c. burnout d. accident proneness e. emotional breakdowns f. apathy g. indifference h. poor judgment i. disinterest in introspection
What is evidence-based practice?
a. the integration and application of nursing research findings, patient care data, preferences, and values, and nursing expertise to nursing practice
Illness behavior of coping ability:
i. The strategies a person uses to assess and manage demands ii. Each patient has a unique coping repertoire. iii. With acute illness, coping behaviors are generally short-term and lead to pre-illness state. iv. With chronic disorders, coping behaviors must be used continuously.
The Code of Ethics for Nurses
i. There are nine provisions accompanied by interpretations ii. 3 describe nurses' fundamental values and commitments iii. 3 address boundaries of duty and loyalty iv. 3 address aspects of duties beyond individual patient encounters. v. The code exists to strengthen and guide nurses decisions are the face ethical dilemmas.
Illness behavior of Dependence:
i. Patients vary along a continuum in their response to illness. ii. Some adopt a passive attitude and overly rely on others to care for them. iii. Others continue denial and try to live as independently as before becoming sick. iv. Most function between these two extremes. v. Behaviors may be the patient's way of signaling an increased need for security or support; independence may not be the desired outcome. vi. Both overly dependent and overly independent behavior can be frustrating to nurses.
In which setting are the majority of nurses employed?
hospitals
Illness behavior of resilience:
i. A successful adaptation despite challenging or threatening circumstances ii. Resilience can be a result of three factors: 1. Disposition: temperament, personality 2. Family factors: warmth, support, organization 3. Outside support factors: supportive network, success in school or work
Nursing's Social Policy Statement
i. Framework for understanding nursing's relationship with society and nursing's obligation to those who received professional nursing care. ii. Contemporary definition of nursing.
Nursing Scope and Standards of Practice
i. Outlines expectations of the professional role of practice ii. Delineates standards of care.
Illness behavior of resourcefulness:
i. Refers to the use of cognitive skills that minimize the negative effects of thoughts. ii. Self-mastery: reduces feelings of despair and helplessness. Resourcefulness can be taught as a form of coping. iii. These skills include: 1. Stress inoculation 2. Self-regulation 3. Problem solving 4. Conflict resolution 5. Emotion management
Illness behavior of Spirituality:
i. belief in a higher power, interconnectedness among living beings, and an awareness of life's purpose and meaning ii. Religion differs from spirituality. iii. Spiritual beliefs may have psychological, medical, and financial benefits that are scientifically proven in the future. 1. Herbert Benson's "relaxation response" can utilize prayer. iv. Nurses are encouraged to view spirituality as one aspect of the whole person that can be used in coping with illness. v. Nurses' responsibility is to refrain from trying to influence patients' religious beliefs
What is society's image of nursing, both positive and negative?
positive- Ethical and caring Negative- less intelligent, sex icon, submissive
predominant gender, age, and racial/ethnic demographic profile of nurses in the US.
• 93% are female. • Average age of graduates from all nursing programs is 31. • BSN is 28 • ADN and diploma are 33 • Median age is 46. • 83.2% white
Certification:
validation of specific qualifications demonstrated by an RN in a defined area of practice. i. Goes beyond licensure to validate a high level of knowledge and proficiency in a practice area ii. Means of promotion and is voluntary 1. American Nurses Credentialing Center (ANCC)- largest certification body in US a. 40 diff. certification programs for BSN and advanced degrees iii. Cert is possible at different edu levels 1. Advanced practice nurse: APRN, BC- mandatory for APN 2. Bachelor's degree: RN, BC- voluntary 3. Diploma and ADN: RN, C iv. Multiple US certifying organizations cause lack of uniformity and can cause confusion v. ANCC recommend standardization of certification
Fidelity:
values of faithfulness to one's responsibilities
Which body enforces the nurse practice act in each state?
• *State board of nursing* o Publishes rules and regulations that expand law o Revised to keep up with the new health care developments.
What is the legal statute that defines nursing practice for a nurse?
• *The nurse practice act* is the statue that defines nursing practice. o Accomplishes four objectives Defines practice of professional nursing Sets educational and other requirements for licensure Determines legal titles and abbreviations Provides for disciplinary action o Also defines authority of the state board of nursing.
What was nursing's first code of ethics?
• A written, public document that reminds practitioners and the public they serve of the specific responsibilities and obligations accepted by the profession's practitioners. • Since the inception of formalized education for nurses, the practice of nursing has been guided by ethical standards promoted by Nightingale and thereafter by nursing groups. • "In 1893 long before these codes were written, "the Florence Nightingale Pledge" was created by a committee headed by Lystra Eggert Gretter and presented to far rand training school for nurses located at Harper hospital in Detroit Mi. *The nightingale pledge functioned as nursing a first code of ethics."*
CH 3 Review each of the Key Points on page 65.
• Commitment to a profession is different from having a job or an occupation. • A review of scholarly writing about professions reveals that there are several characteristics that all professions have in common. • A body of knowledge, specialized education, and service to society, accountability, autonomy, and ethical standards are a few of the hallmarks of professions. • Nursing is still troubled by questions of autonomy, educational programs, and commitment practice. • Nursing's Social Policy Statement: The Essence of the Profession is nursing's contract with society. • Being a professional is a dynamic process, not a condition or state of being. • Professional growth beings during professional education and evolves throughout the different stages of nurses' careers.
What was the Johnson & Johnson Campaign for Nursing's future all about?
• Did campaign "to enhance the image of the nursing profession, recruit new nurses and educators, and to retain nurses currently in the system. • Did print media, TV ads, student scholarships, fundraising and research.
What is the definition of negligence?
• Failure to act as a reasonably prudent person would act in the same circumstances
What are the causes of negligence that commonly result in malpractice lawsuits (page 75)?
• Failure to follow standards of care, including failure to: o Perform a complete admission assessment or design a plan of care o Adhere to standardized protocols or institutional policies and procedures o Follow a physician's verbal or written orders. • Failure to use equipment in a responsible manner including: o Follow manufactures recommendations for operating o Check equipment for safety o Place equipment properly during use o Learn how equipment functions • Failure to communicate • Failure to document • Failure to assess and monitor • Failure to act as a patient advocate.
CH 2 Review each of the Key Points on page 49.
• In 1860, Nightingale founded a school for nurses at St. Thomas Hospital in London that became the model for nursing education in the US. • Formal educational programs for US nurses were established in 1873. • The period between the 1893 World's Fair and 1908 marked a time of organizing for nurses, including the formation of forerunners of the NLN, ANA, ICN, and the NACGN. • The initiation of state licensure in 1903 heralded standardization of nursing education programs that, until this time, had varied widely. • The establishment of the Henry Street Settlement and the rise of community health nursing played a major role in the widespread public acceptance of nurses, particularly African-American nurses. • WWI and the influenza epidemic of 1917-1919 created a strong demand for nursing services. Many nursing schools opened in response, mostly in hospitals. • The Great Depression and WWII created new opportunities for nurses; since WWII, hospital expansion, technologic advances, and social changes have created new and progressively autonomous roles for nurses, esp advanced practice nurses. • In the 1980's, the recognition of AIDS as an infectious disease related to HIV changed the delivery of health care at all levels. • Social trends that have affected nursing include "graying of America", cultural diversity; men to nursing; and technologic advances in genetics, health care and information management. • The nursing shortage is projected to worsen in the next few years • Individual nurses must take direct action when nursing is presented in an unfavorable light in the media • Imbalances in the supply of and demand for nurses arise periodically because of changes in society and in health care itself. A number of ongoing initiatives have been designed to ensure an adequate supply of RNs, yet shortages continue.
How does the nurse licensure compact work? What if you are licensed in one state (like you live in Tennessee), but you practice as an RN in another compact state (like Mississippi)? Which nurse practice act are you subject to?
• It allows an RN to have one license (in the state of residency) yet practice in another compact member states without an additional license in the state of employment. • The nurse is subject to the nurse practice act in the state where he or she is practicing.
What is the name of the licensure exam for nursing and when does a nurse take it?
• National Council Licensure Examination for Registered Nurses (NCLEX-RN) • Take the test after an individual has successfully completed their basic nursing education from a state accredited school of nursing are eligible to sit for the licensure exam.
what is the employment outlook is for nursing in the future (page 21)?
• Nurses can expect their employment opportunities to grow "much faster than the average" about 22% though the year 2016. • 581,500 RN jobs will be created.
CH 4 Review each of the Key Points on page 85.
• Nurses must recognize that the law is a system of rules that governs conduct and attaches consequences to certain behavior. • Consequences include civil or criminal action or both • Nursing practice is limited by the definition of practice in the state nurse practice act and the qualification for licensure to practice nursing in that state • The law is dynamic and must be responsive to society's need • Broadening the scope of nursing practice has increased the possibility for legal actions involving nurses. • Technologic advances have increased concern about informed consent and patients' rights to direct the care they choose to receive or refuse • The use of social media may blur the lines between personal and professional boundaries; however, the nurse needs to maintain firm professional boundaries with current and former patients when using social media. • Many nurses possess inadequate knowledge of legal issues that affect nursing practice every day. These issues deserve increased attention by nurses in all areas of practice.
CH 1 Review each of the Key Points on page 22
• Nursing is the largest workforce in health care in the US. The influence of nursing is not as powerful as it could be because the large majority of nurses do not belong to professional organizations such as ANA, a federation of state nurses associations that is the voice of nursing. • More than half of working nurses are employed in hospitals, a traditional setting for nursing practice; this may change as health care in the US becomes more community based. • Increased use of APNs as providers of primary care may be part of the solution to the American health crisis that is caused by the aging of the baby boom generation, the fast- growing of technologic advances, and the critical need for cost- containment measures in the health care sector. • APNs are capable of delivering high quality care to many segments of the population who don't have adequate care. • The affordable care act will create more opportunities for practice for nurses • Nursing will continue to be a profession in high demand over the next several years.
What are the barriers to professionalism in nursing (see slides and text)?
• Varying levels of preparatory education o Nurses can be licensed to practice without a bachelor's level of education, as required by other professions. • Gender Issues o There is a diminished value of female-dominated professions such as nursing social work, and teaching. Society devalues "women's work" • Historical influences o Religion and military inculcate values of unquestioning obedience o Altruism can devalue autonomy and fair economic valuation. • External conflict o conflicts with medicine have arisen as nurses are able to provide services that were formerly part of medical practice by physicians. o The legal scope of nursing practice must be protected through lobbying and legislation. • Internal conflicts o Nursing's power and influence is fragmented by subgroups and dissensions, including differences in educational levels and proliferation of organizations that compete for nurses' membership. o Fewer than 10% of the 3 million nurses are members of the ANA in the US. The fact that most nurses are not members of any professional organization hampers nursing's ability to govern itself, set standards, and use its collective power to lobby effectively.
What was the purpose and findings of the Woodhull Study (page 41)?
• Was a comprehensive study of nursing in the print media from University of Rochester. • Findings were that "Nurses and the nursing profession are essentially invisible to the media and , consequently, to the American public"
How do you define "profession"?
• Work requiring advanced training and usually involving mental rather than manual effort. Usually has a code of ethics and a professional organization.
