Ch. 3 The Influence of Contemporary trends and Issues on Nursing Education

In preparing students for professional nursing practice in the twenty-first century, where should the emphasis be placed? a. Care coordination, direct care for complex clients, and outcomes evaluation b. Chemistry, biostatistics, and computer programming c. Illness care, hospice, and ethics. d. Psychomotor skills, obstetrics, and epidemiology

ANS: A Caring for complexities in practice, coordinating care, and focusing on outcomes evaluation are the tasks that reflect the direction in which nursing is heading. As supplemental courses to nursing, these are essential but they do not represent an area of emphasis for professional nursing. Illness care, hospice, and ethics are currently components in programs that are preparing students for professional nursing. Psychomotor skills, obstetrics, and epidemiology are limited in scope. DIF: Application REF: Pages 44-46

14. An RN with a diploma preparation wants to participate in decisions about health care and decides the first step is to obtain a BSN. The nurse enrolls in a nursing program offering self-scheduling and a self-paced curriculum. This nurse is taking advantage of: a. educational mobility. b. a traditional nursing program. c. training for advanced practice nursing. d. credit by examination.

ANS: A Education mobility is the progressive movement from one level or type of education to another, in this instance, diploma to BSN. Programs are aimed to make the transition possible through creative flexible scheduling. Traditional nursing programs have set schedules, often face-to-face lectures offered in a full-time format; although some programs are web-assisted, the majority require the student to be on campus for most learning experiences. A BSN is not an advanced practice degree. Although credit by examination may be a part of a nontraditional nursing program, it is only a portion and does not characterize the type of learning. DIF: Application REF: Page 64

8. When focusing on addressing issues identified by the 2000 Institute of Medicine report, the nursing faculty will access information associated with which initiative? A. Quality and Safety in Nursing Education B. Competency Outcomes and Performances Model (COPA) C. The National Organization of Nurse Practitioner Faculties (NONPF) D. Academic Center for Evidence-Based Practice (ACE)

ANS: A In response to the Institute of Medicine report (IOM, 2000), The Robert Wood Johnson Foundation funded a national initiative, Quality and Safety in Nursing Education (QSEN), to help nursing programs recognize curricula to focus on patient safety and quality care. None of the other options are based on that report.

4. The new trend in nursing education that is consistent with real-world practice is focused on: a. outcomes. b. objectives. c. goals. d. subjective appraisals.

ANS: A Outcomes and criteria establish real expectations for clinical practice and have a powerful influence on nursing education and practice at all levels. Outcomes are used in all areas of nursing in the nursing process. Objectives refer to knowledge that the student is expected to attain. Goals are client focused. Subjective appraisals are not used in real-world practice. DIF: Knowledge REF: Page 46

17. A student nurse is preparing a presentation that requires identification of outcomes for the care of heart failure patients. Which statement represents an appropriately written outcome? A. Develop a teaching program to address physical activities that result in improved cardiac function. B. Discuss the clinical manifestations associated with Level 4 heart failure. C. List the most common pharmaceutical approaches to reduce preload in heart failure patients. D. Recognize the economic impact the recidivism has on the patient and health care facility.

ANS: A Outcomes use action words, actions that nurses do, such as develop, plan, implement, integrate, plan, or conduct.

3. Although the use of technology and the Internet provides nursing faculty and students with unlimited resources and current information, an outcome associated with this trend is that: a. users of electronic resources spend a disproportionate amount of time looking for pertinent content. b. additional time is available to study and revise curricula because special skills are not needed to access information via the Internet. c. immediate results and outcomes are expected from students and faculty, thus enhancing time management. d. skills that require problem-solving and reflective abilities are developed.

ANS: A Students can easily become distracted by pursuit of the intriguing web of links they encounter while they search websites to complete assignments or find pertinent content. Students must learn to become computer literate and competent. Success in nursing courses and practice depends on these skills. With unlimited information available to them, students may actually take more time to navigate Web-based resources than is needed for review of traditional print-based resources. Learning from the Internet helps students develop skills in analytic thinking, decision making, and reflective judgment. DIF: Analysis REF: Pages 43-46

A potential nursing student is visiting the website of some nursing programs and notes that the school states, "The curriculum is built on the Essentials of Baccalaureate Education to ensure that this nursing program meets the standards set for educating nurses at the baccalaureate level." Which organization oversees professional nursing programs and establishes these essentials? a.American Association of Colleges of Nursing (AACN) b.American Nurses Association (ANA) c.National Council of State Boards of Nursing (NCSBN) d.National League for Nursing (NLN)

ANS: A The AACN publishes the Journal of Professional Nursing, The Essentials of Baccalaureate Education, and other related documents pertaining to the BSN and higher degree education. The ANA is the major national organization that is concerned with a broad scope of practice issues. The NCSBN is the organization of all state boards of nursing that coordinates licensure activities at the national level. The NLN is the national organization of nurse educators that has a long-standing commitment to four types of basic programs: LPN, diploma, ADN, and BSN. DIF: Knowledge REF: Page 65

9. The number of reported medical errors demonstrates a need for what priority intervention? A. Simulation experiences B. Performance competency exercises C. Comprehensive instructor-constructed examinations D. Detailed care planning exercises

ANS: B The increase in reported medical-related errors vividly emphasizes the need for more effective validation of performance competence in schools and the workplace.

16. A nurse realizes that a recent health care concern related to globalization was: a.the emergence of epidemic hepatitis A. b.the pandemic of H1N1 "swine flu." c.reemergence of polio. d.an increase in chronic illnesses.

ANS: B There was a pandemic of H1N1 on every continent Hepatitis A is not related to globalization; rather the most common cause is lack of simple handwashing. Polio has been almost nonexistent in the United States since the 1960s.Globalization does not affect chronic illness. DIF: Knowledge REF: Page 44

1. A nurse is concerned that the policy of using povidone-iodine (Betadine) to clean foot ulcers may lead to unwarranted allergic reactions and drying of surrounding tissue. A literature review is performed to determine the "best practice" related to care of foot ulcers. This nurse: (Select all that apply.) a applying evidence-based practice to the clinical setting. b. using critical thinking to change procedures performed in the care of foot ulcers. c. is participating in research to provide cost-effective care (soap is less expensive than povidone-iodine). d. is demonstrating clinical competence in health assessment and in application of theory to the clinical setting. e. is using information to problem-solve and ensure safe, competent care.

ANS: A, B, E Critical thinking is an essential part of applying evidence-based practice that is using research findings to guide actual practice. Evidence-based research, not cost, should be used to guide actual practice. The nurse is demonstrating clinical competence by using assessment skills and by noting the effects of povidone-iodine and applying evidence-based practice to change procedures performed in the care of foot ulcers. DIF: Analysis REF: Pages 46, 51

The purpose of recent research conducted jointly with nurses and physicians participating in the Advisory Council on Nursing Education and Practice and the Council on Graduate Medical Education was: a. to reduce medical costs by eliminated unnecessary diagnostic tests. b. improved interdisciplinary efforts between nurses and physicians to improve client safety and reduce errors. c. globalization of health care to Third World countries. d. ways to ensure confidentiality when sharing client data between nurses and physicians in today's technology-driven health care.

ANS: B Collaborative education is key to ensuring client safety. This study was conducted jointly with nurses and physicians to improve safety and reduce errors. The aim was not a reducing cost rather improving safety and reducing errors. The aim was not toward globalization. This study focused on interdisciplinary collaboration and safety rather than technology and concerns such as confidentiality. DIF: Comprehension REF: Page 47

15. A nursing student scores 95% on the written examination for the adult health course. To be successful in this course, this same student must then perform an indwelling catheter insertion and wound care in a simulated environment meeting core competencies. The student asks, "What are core competencies?" The nursing instructor replies, "core competencies are: a. a trend used in nursing education to reduce attrition in prelicensure students." b. those skills necessary for safe competent nursing practice." c. educational opportunities that provide remediation when a student is unable to perform psychomotor skills correctly." d. critical thinking exercises aimed to improve reading and math skills."

ANS: B Core competencies are those skills and elements that are fundamental and essential for safe competent practice. The aim is not to reduce attrition but to ensure students have skills needed to provide safe care in today's dynamic healthcare environment. Critical elements are the components of any skill required to produce safe competent care. The aim is not to improve reading and math skills rather critical thinking related to the practice of nursing. DIF: Comprehension REF: Page 42

13. When preparing to complete a competency exam involving a neurologic assessment in a simulation laboratory, the nurse reviews the critical elements, which consist of: a.those steps that result in the life or death of a client. b.required criteria that must be incorporated into the assessment for the desired outcome. c.fundamental strategies unique to complex dynamic care environments. d.objective data that can be used to determine the likelihood that the client will recover.

ANS: B Critical elements include the application of mandatory principles that must be used according to established practice standards. Critical elements work to achieve desired outcomes for the client. Critical elements are not strategies. Critical elements are based on the application of mandatory principles, not on objective data, to determine the likelihood that the client will recover. DIF: Comprehension REF: Page 51

6. The first university to offer nursing graduates a baccalaureate degree was: a. Columbia Teachers College. b. Yale University. c. Harvard University. d. the New York Regents Program.

ANS: B In 1924 Yale University offered the first separate Department of Nursing, whose graduates earned a baccalaureate degree. Columbia Teachers College was the first to offer a doctor of education degree. Harvard University does not offer a baccalaureate program in nursing. The New York Regents Program is a distance mobility program. DIF: Knowledge REF: Page 61

20. A person interested in employment in the health care sector has less than 1 year to devote to education and wants to focus on functional aspects of patient care in a long-term facility. Which type of nursing program should this person request information about? A. Bachelor's degree in nursing (BSN) B. Licensed practical nurse (LPN) C. Associate's degree in nursing D. Master's degree in nursing

ANS: B LPN programs provide basic technical bedside care and employment opportunities at hospitals, nursing homes, home care and doctor offices.

A standardized means of determining initial proficiency at the entry-level into nursing is: a. certification in medical-surgical nursing. b. the National Certification Licensure Examination (NCLEX®). c. instructor-constructed examinations that are comprehensive in nature. d. the ability of the student to answer questions related to the care provided to a patient during the senior nursing courses.

ANS: B NCLEX is the national licensure examination that is based on the minimal level of safety required for a nurse to enter practice. Certification in medical-surgical nursing is attained through a specialty examination for AACN certification that can be taken only by registered nurses. Instructor-constructed examinations are based on instructors' knowledge and experience and are not used for entry into practice. The ability of the student to answer questions related to the care provided to a patient during the senior nursing courses describes a non-standardized means of determining initial proficiency. DIF: Knowledge REF: Page 61

5. The practice of nurses, nursing students, and faculty are affected by demographic changes due to: a. the growing percentage of adults ages 50 to 65 years. b .increasing numbers of obese children and adults. c. changes by which families are becoming more nuclear. d. social programs that are essentially eliminating poverty.

ANS: B The United States is experiencing an epidemic of obesity with major consequences for health and the health care system. The percentage of adults ages 50 to 65 years is not increasing. The number of very old adults is increasing. Even the definition of family has changed radically, as evidenced by single individuals living with other single individuals, single-parent households, and same-sex couples (with and without children).The number of families who remain uninsured, jobless, homeless, and surviving in poverty is increasing. DIF: Knowledge REF: Pages 52-53

7. The nursing model that is referred to as the "class without walls" is which model? a.Articulation b.Career ladder (2 + 2) c.External degree d.Second degree

ANS: C An external degree does not require attendance and provides no course classes; it enrolls thousands and is accessible regardless of geographic location. Articulation is the format of a program or refers to what the student must do to complete the program. The 2 + 2 option is for LPN or RN students to continue their education to RN or BSN, respectively. A second degree is a degree that is pursued after the first degree has been obtained.DIF: Knowledge REF: Page 64

2. One of the major trends that currently influence nursing education and practice is: a. increased technology in the field of critical care. b. a narrowing scope of practice for nurses. c. incivility or disregard of others' rights in social interactions. d. a decrease in ethnicity due to international programs allowing students to study from a distance. (Distance learning programs)

ANS: C Incivility has escalated with the use of text-messaging during class and academic dishonesty. Critical care is not the only area in which technology is increasing, and this has no direct effect as a major trend influencing nursing education. The scope of practice is becoming broader, including community and global settings. The number of diverse ethnic minorities and illegal immigrants is increasing. DIF: Application REF: Pages 43-56

11. The NCLEX examination is created and administered by the: a. American Association of Colleges of Nursing (AACN) .b. American Nurses Association (ANA). c. National Council of State Boards of Nursing (NCSBN). d. National League for Nursing (NLN).

ANS: C The NCSBN coordinates licensure activities on a national level and creates and administers the licensure examination (NCLEX).The AACN is an organization of deans and directors of baccalaureate and higher degree nursing programs that establishes standards for programs and is concerned with legislative issues that pertain to professional nursing education. The ANA is the major national nursing organization concerned with broad scope practice issues, standards of practice, scope of practice, ethics, legal issues, and employment; it consists of a federation of state nurse associations. The NLN is a national organization of nurse educators that has a long-standing commitment to four types of basic programs: LPN, diploma, ADN, and BSN. DIF: Knowledge REF: Page 65

12. A student is planning to enroll in prerequisite courses after graduating from high school and is researching options for nursing programs. During a career fair, the student compares different types of nursing education programs and discovers that: a. diploma programs focus on family and community, with an emphasis on health promotion. b. most practicing RNs graduated from diploma programs because this was the first type of RN program. c. baccalaureate programs focus on technical and hands-on nursing skills in diverse community settings. d. master's programs such as that for the clinical nurse leader provide entry into practice with a focus on interdisciplinary and bedside nursing care for complex client populations.

ANS: D A clinical nurse leader oversees the care coordination of groups of clients and actively provides direct client care in complex situations, evaluates client outcomes, and has the decision-making authority to change care plans when necessary. Diploma programs do not focus on community, with an emphasis on health promotion, although baccalaureate programs do have this focus. Most of today's practicing RNs graduated from ADN programs.BSN programs focus on the care of clients, with greater emphasis on the family and community and on health promotion and illness prevention. DIF: Application REF: Page 62

A current trend is for students to be evaluated to determine whether they demonstrate competence in the actual client care environment or with a standardized patient. This process occurs in addition to or instead of traditional pencil-and-paper evaluations. This type of evaluation is referred to as: a. core practice competencies. b. continuing competence c. distance learning. d. performance-based assessment.

ANS: D Performance-based assessment is the evaluation of abilities based on an objective demonstration of specific required competencies. This may include performance in actual or simulated situations. Core practice competencies consist of the abilities and skills currently required for program completion and nursing practice. Continuing competence is required in many states for re-licensure and recertification. Distant learning occurs when courses are delivered through some electronic format such as a Web-based course. The course may be presented a great distance from the student, who is never required to attend a class at a physical location. DIF: Knowledge REF: Page 51

18. A member of a nursing student study group comments, "We spend some time early in the class discussing key facts than most of the time working through case studies, then practicing on the simulator rather than caring for 'real' patients. " This teaching-learning style represents what form of nursing education? A. Skill-based learning B. Objective Structured Clinical Examinations (OSCE) C. Peer-to-peer learning D. Practice-based competency

ANS: D Practice-based competency includes active engagement and application in real practice situations and interactive strategies such as case studies and simulation.

10. Which trend is an effect of the nursing shortage on nursing education and ultimately a safety issue regarding client care? a. Only devoted qualified nurses are continuing to provide bedside nursing because of the complexity of care required, resulting in excellent preceptorships for students. b. The number of applicants to nursing programs has risen but enrollment is limited because of a decrease in the number of available scholarships and grants. c. With an increase in the number of nurses who are entering graduate school to escape bedside nursing, students can soon enjoy a lower faculty/student ratio. d. Students may be assigned to preceptors who have not yet developed expertise in the field of interest.

ANS: D Qualified preceptors are few. There is a shortage of nurses qualified at the bedside who are available to serve as preceptors for students. Nursing enrollments are limited because of a shortage of faculty. Nurses are not entering graduate school to escape bedside nursing, but to pursue advanced practice degrees. DIF: Analysis REF: Page 56

19. Which experience is best designed to support a nursing student's preparation for interprofessional team participation? A. Attending a seminar on interprofessional team cooperation B. Completing a preceptorship with an advanced practice nurse C. Carry for three patients with varying medical diagnoses D. Presenting patient information at the daily care planning meeting

ANS: D While interprofessional education are encouraged for all health care disciplines, Delunas and Rouse (2014) cite the importance of preparation of students for interprofessional education experiences, and the need for regular meetings when students are engaged in learning as a member of a health care team.

2. According to Lenburg, the use of practice-based assessments in nursing education is aimed toward the target of __________.

ANS: competence The target that students need to meet to practice safely in today's complex health environment is achieving competence in meeting critical elements and demonstration of practice-based skills. DIF: Comprehension REF: Page 47

1. The oldest, most traditional type of program that prepares a candidate for RN licensure is the hospital-based ____________________ program.

ANS: diploma The earliest training programs for nurses were hospital based and designed to meet the needs of the particular institution; these were referred to as diploma programs. DIF: Knowledge REF: Page 59