Dimensions Test 3

Know novice versus seasoned critical thinking skills and abilities

1. Novices: Beginners who lack experience in specific situations (e.g., a new graduate with no experience in nursing or an experienced psychiatric nurse who is beginning to work in obstetric nursing) 2. Advanced beginners: Those with marginally acceptable performance based on a foundation of experience with real situations (e.g., a nurse who is in the first year of employment or the first year of a new clinical specialty) 3. Competent: Those with 2 or 3 years of experience in similar situations (e.g., a nurse who has practiced emergency and intensive care nursing for 2 or 3 years) 4. Proficient: Those with broad experience that allows meaning to be understood in terms of the big picture rather than isolated observations (e.g., a nurse who is in charge of making patient assignments) 5. Expert: Those with extensive experiences that enable an intuitive grasp of situations and problems (e.g., an experienced nurse who serves as charge nurse, preceptor, or member of a committee) *Novice* • Knowledge is organized as separate facts. Rely heavily on resources (e.g., texts, notes, preceptors). Lack knowledge gained from experience (e.g., listening to breath sounds). • Focus so much on actions that they tend to forget to assess before acting • Need clear-cut rules • Hampered by unawareness of resources • Hindered by the brain-drains of anxiety and lack of self-confidence • Have limited knowledge of suspected problems; therefore they question and collect data more superficially • Rely on step-by-step procedures. Tend to focus more on procedures than on the patient response to the procedure. • Become uncomfortable if patient needs preclude performing procedures exactly as they were learned • Follow standards and policies by rote • Learn more readily when matched with a supportive, knowledgeable preceptor or mentor *Expert* • Knowledge is organized and structured, making recall of information easier. Have a lot of experiential knowledge (e.g., what abnormal breath sounds are like, what subtle changes look like). • Assess and think things through before acting • Know when to bend the rules • Aware of resources and how to use them • Self-confident, less anxious, and more focused • Have a better idea of suspected problems, allowing them to question more deeply and collect more relevant and in-depth data • Know when it's safe to skip steps or do two steps together. Are able to focus on both the parts (the procedures) and the whole (the patient response). • Comfortable with rethinking procedure if patient needs necessitate modification of the procedure • Analyze standards and policies, looking for ways to improve them • Are challenged by novices' questions, clarifying their own thinking when teaching novices

Concerns with fetal cell research

1. Paying for fetuses: A concern is whether the fetal tissue research scientists are paying others for these aborted fetuses. If payment is being made for aborted fetuses, it would seem to violate both the laws that prevent payment for organs used in transplantation and the moral respect for humanity. Questions also arise concerning who is giving permission for the use of fetuses in transplantation procedures. Does anyone really own them? 2. Potential for abuse: Because of the immaturity and lack of differentiation of cells during the first trimester of pregnancy, the best fetal tissue comes from fetuses aborted during the second trimester. Most scientists agree that second-trimester fetuses have well-developed nervous, cardiovascular, gastrointestinal, and renal systems and are capable of feeling pain. Even though fetal tissue research has not led to an increase in abortions, the potential for abuse is tremendous. 3. In Vitro Fertilization: Another important ethical issue concerns the use of in vitro fertilization as a source for fetal tissue. Many religious groups question the morality of the procedure itself. Even if in vitro fertilization is considered ethical for procedures such as surrogate motherhood, is it ethical to create fetuses that are going to be used only for research and transplantation? From whom are the ova and sperm coming? Have these donors given permission for such use of their tissues? What about the rights of a fetus that was created in a test tube without ever having a hope of a normal life?

Primary vs Secondary vs Tertiary Care

1. Primary care refers to health promotion and preventive care, including programs such as immunization campaigns. Primary care focuses on health education and on early detection and treatment. Maintaining and improving optimal health is the overriding goal. 2. Secondary level the focus shifts toward emergency and acute care. Secondary services are frequently provided in hospitals and other acute care settings, with an emphasis on diagnosis and the treatment of complex disorders. 3. Tertiary level emphasizes rehabilitative services, long-term care, and care of the dying.

Criminal law

Criminal laws are concerned with providing protection for all members of society. When someone is accused of violating a criminal law, the government at the county, city, state, or federal level imposes a punishment that is appropriate to the type of crime. Criminal law involves a wide range of malfeasance, from minor traffic violations to murder. 1. Misdemeanor: minior criminal offense 2. Felony: major crimnal offense Defendant: an individual accused of a crime

Define Culturally Competent Care

Despite the relatively low number of minority nurses, it is expected that nurses from one culture should be able to give culturally competent care to individuals from any other culture. the provision of effective care for clients who belong to diverse cultures, based on the nurse's knowledge and understanding of the values, customs, beliefs, and practices of the culture.

Define Diversity

Diversity is a term used to explain the differences between cultures. The characteristics that define diversity can be divided into two groups: primary and secondary.

Ethics

Moral principles that govern a person's or group's behavior.

Affordable Care Act (ACA)

Provide affordable health care to us citizens who before its passage in 2010 were unable to pay for or obtain health insurance aka Obamacare

How do you assess culture?

Purnell's Model for Cultural Competence

Definition and purpose of unified nursing language and taxonomy

The ANA Database Steering Committee was formed in 1991 to develop a common nursing language called the Unified Nursing Language System (UNLS). UNLS maps concepts by identifying common terms from different vocabularies and acknowledging them as synonyms of the same concept.

Federal Mediation and Conciliation Service

The Federal Mediation and Conciliation Service is an independent agency of the United States government, founded in 1947, which provides mediation services to industry, community and government agencies worldwideThe Federal Mediation and Conciliation Service is an independent agency of the United States government, founded in 1947, which provides mediation services to industry, community and government agencies worldwide Mediation- a form of alternative dispute resolution that can be either formal or informal

State Board of Nursing

The boards of nursing (BONs) that comprise NCSBN protect the public's health and welfare by assuring that safe and competent nursing care is provided by licensed nurses. BONs achieve this mission by outlining the standards for safe nursing care and issuing licenses to practice nursing.

Moral principles

The fundamental standards of right and wrong that an individual learns and internalizes, usually in the early stages of childhood development. An individual's moral orientation is often based on religious beliefs, although societal influence plays an important part in this development.

What are the characteristics of the ideal electronic health record?

The ideal EHR would be a lifelong continuous record of all the care the client has received, rather than the episodic, piecemeal data that it now provides. This one record would reflect an individual's current health status and lifetime medical history. It would be unique to the person and not to the institution. This record would reside in multiple data sites and would accept multiple data types (e.g., graphs, pictures, x-rays, text) and be accessible worldwide.

Tools for clinical reasoning

The process you use to think about issues at the point of care (deciding how to manage/prevent patient problems) Questioning and dialogue are essential tools for assessing thinking. SBAR- Situation, background, assessment, recommendation

Three primary methods communication

Verbal, Paraverbal, or Nonverbal Communication • Verbal communication is either written or spoken and constitutes only about 7 percent of the communicated message. • Nonverbal communication makes up the other 55 percent of communication and includes body language, facial expressions, gestures, physical appearance, touch, and spatial territory (personal space). • Paraverbal is the tone, pitch, volume, and diction used when delivering a verbal message. How people say something is often more important than what they are saying. A sentence can have a completely different meaning by placing emphasis on different words. Paraverbal communication makes up about 38 percent of the total message and is often considered part of nonverbal communication

Descriptive Ethics

A bottom-up approach to ethics that starts with what society is already doing ethically and developing ethical principles based on the observed actions of people rather than starting with ethical principles and applying them to society such as normative ethics does. There are no preset values in descriptive ethics except for the consistent ethical decisions that are already being made by the majority of members of society. It is also sometimes called comparative ethics and forms the basis for situational ethics and the utilitarian system of ethics. Although widely used in politics, economics, and business, it creates additional issues for health-care providers when applied to difficult health-care decisions.

Nursing Process

assessing diagnosing planning implementing evaluating

What is the long-term economic impact?

nursing shortage will become more pronounced.

Describe the different spiritual practices

prayer & meditation relief through imagery relaxation therapeutic touch

Compare advantages/disadvantages of electronic health record with paper health record.

*Advantages:* • People know how to use it. • It is fast for current practice. • It is portable. • It is unbreakable. • It accepts multiple data types, such as graphs, photographs, drawings, and text. • Legal issues and costs are understood. *Disadvantages:* • It can be lost. • It is often illegible and incomplete. • It has no remote access. • It can be accessed by only one person at a time. • It is often disorganized. • Information is duplicated. • It is hard to store. • It is difficult to research, and continuous quality improvement is laborious. • Same client has separate records at each facility (physician's office, hospital, home care). • Records are shared only through hard copy.

Be able to define and apply the following concepts: adverse event, sentinel event, medication error, never event

*Adverse events:* unexpected medical occurrence in a patient or an adverse event is any undesirable experience associated with the use of a medical product in a patient. (if serious, should be reported to FDA). *Sentinel event:* unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof including loss of limb or function. Relatively infrequent, occurring independently of a client's condition, that commonly reflect hospital system and process deficiencies and result in negative outcomes for clients. Sentinel events are not the same as medical errors. *Medication error:* any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. *Never event:* A list of reasonably preventable medical errors that occur in hospitals that will no longer be paid for by Medicare in an attempt to control costs.

Forensic nurses: Legal nurse consultant, examiner, psychiatric, correctional, SANE

*Forensic nursing* is an emerging field that forms an alliance among nursing, law enforcement, and the forensic sciences. The term forensic means anything belonging to, or pertaining to, the law. *Legal nurse consultant* licensed RN who critically evaluates and analyzes health-care issues in medically related lawsuits. Because the legal system is involved, nurses acting as consultants are considered to be practicing forensics. Nurses uniquely combine their medical expertise with legal knowledge to assess compliance with accepted standards of health-care practice. Sexual Assault Nurse*Examiner:* A SANE is an RN trained in the forensic examination of sexual assault victims. This person has an advanced education and clinical preparation specialized in this area. *Psychiatric:* Forensic psychiatric nurses work with individuals who have mental health needs and who have entered the legal system. These nurses generally practice in state psychiatric institutions, jails, and prisons. *Forensic Correctional Nurse:* Correctional facilities reflect the demographics of the general population, with an increasingly aging incarcerated population who have age-related health-care problems. Forensic correctional nurses provide health care for inmates in correctional facilities such as juvenile centers, jails, and prisons. They manage acute and chronic illness, develop health-care plans, dispense medications, and perform health screenings and health education. Forensic correctional nurses conduct psychiatric assessments and respond to emergency situations. The role of the forensic correctional nurse offers a high level of autonomy compared with other nursing roles.

Know the organizations who promote quality and patient safety and what they do

*Institute of Medicine (IOM)* - provide evidence-based research and recommendations for public health and science policy *Leapfrog Group* - improve the quality and safety of healthcare and make it more affordable, now serves as the gold standard for comparison of hospital performance on national standards of safety, quality, and efficiency, thereby facilitating transparency and easy access to health-care information. *Agency for Healthcare Research and Quality* - uses quality indicators (QIs) as measures of health-care quality from easily accessible inpatient hospital administrative data.

Difference between integrative medicine (therapy from within) and conventional medicine (therapy from outside)

*Integrative medicine:* plants or natural medicine unique individual focus on health and wellness natural/noninvasive *Conventional medicine:* chemotherapy disease category focus on disease and illness technological/invasive -Focuses on the physical or material part of the person, the body. It is concerned with the structure, function, and connections or communication between material elements that compose the body, such as bones, muscles, and nerves. Conventional medicine generally views all humans as being very similar biologically. Disease is seen as a deviation from what is generally considered to be a normal biological or somatic state.

What is the Impact of aging populations?

*Long-Term Effects on Nursing* As more of the elderly seek health care, the nursing shortage will only become more pronounced. *Burden on the Health-Care System* An aging population will place an increased burden on an already stressed health-care system. As the shortage becomes worse, nurses will need to work back-to-back shifts under highly stressful conditions. *Lack of Geriatric Specialists* As more and more of the aging population enters the health-care system, there is an increasing need for practitioners who specialize in elderly care. *Special Education Needs* To provide better holistic care, nurses today must educate the older population. This education is important in improving the health of the community and the everyday lives of the elderly. *Disaster Preparation* Recent disasters, such as Hurricane Sandy, pointed out the special needs of the elderly population in a disaster situation. *Appreciating the Older Population's Spirituality* Older people prefer to remain independent and within their own homes. To an older adult who is either well or ill, this freedom may have a spiritual connection. With aging and changes in health status, many of the elderly find new meanings for their existence. They make preparations for their vertical transcendence from life to death.

Medicare/Medicaid

*Medicare:* is a federal government-sponsored health-care program developed primarily for senior citizens over the age of 65, those with end-stage renal disease, and disabled persons who are eligible to receive Social Security benefits because of their contribution to the Social Security system during their working years. *Medicaid:* differs in that it is primarily for low-income families and low-income individuals.

Physical manipulation Technologies/Ingested or Applied substances/Energy Therapies: guided imagery, therapeutic touch

*Physical Manipulation Technologies.* These are also known as "bodywork therapies." They are administered by a therapist or by the clients themselves as part of a self-care program. They include health rituals and breathing exercises to better bring about the union of body-mind-spirit. *Ingested or Applied Substances.* A number of substances, including herbs, vitamins, and other nutritional supplements, and dietary regimens have the goal of helping the body heal itself, rid itself of toxins, and promote general health and wellness. *Energy Therapies.* These modes of treatment maintain or restore health through the balancing of energy flow in the body. The goal is to restore the natural movement of vital forces or life essences that may have been disturbed by diseases or psychological factors.

Understand appropriate assignments based on license (i.e.; RN, LPN, UAP)

*RN* - performing admission assessments, developing care plans, and making nursing diagnoses are activities generally restricted to RNs only. *LPN & UAP* - Clients who are relatively stable and not likely to experience drastic changes in health-care status are the most suitable for delegation. Low-risk, relatively simple procedure that the RN can easily delegate to an LPN or even UPN.

Define technology, theory and function in nursing informatics.

*Technology:* the early definition of nursing informatics stated that it existed whenever the nurse used any type of information technology in delivering nursing care or in the process of educating nursing students. *Theory:* A mental viewing, proposed idea or plan, formulation of a relationship that helps explain an observable phenomenon. It helps to provide care in an organized manner. *Function:* To manage and process data to help nurses enter, organize, and retrieve needed information.

Pew Commission

*Twenty-One Competencies for the 21st Century* 1. Embrace a personal ethic of social responsibility and service. 2. Exhibit ethical behavior in all professional activities. 3. Provide evidence-based, clinically competent care. 4. Incorporate the multiple determinants of health in clinical care. 5. Apply knowledge of the new sciences. 6. Demonstrate critical thinking, reflection, and problem-solving skills. 7. Understand the role of primary care. 8. Rigorously practice preventive health care. 9. Integrate population-based care and services into practice. 10. Improve access to health care for those with unmet health needs. 11. Practice relationship-centered care with individuals and families. 12. Provide culturally sensitive care to a diverse society. 13. Partner with communities in health-care decisions. 14. Use communication and information technology effectively and appropriately. 15. Work in interdisciplinary teams. 16. Ensure care that balances individual, professional, system, and social needs. 17. Practice leadership. 18. Take responsibility for quality of care and health outcomes at all levels. 19. Contribute to continuous improvement of the health-care system. 20. Advocate for public policy that promotes and protects the health of the public. 21. Continue to learn and help others to learn. *The Pew Commission also went on to identify five key areas for professional education:* 1. Change professional training to meet the demands of the new health-care system. 2. Ensure that the health profession workforce reflects the diversity of the nation's population. 3. Require interdisciplinary competence in all health professionals. 4. Continue to move education into ambulatory practice. 5. Encourage public service of all health-professional students and graduates.

Discuss different threats to security in electronic health systems

*Unauthorized Access:* generally unethical and now is always illegal. *Accidents:* accidental threats involve naturally occurring events such as floods, fires, earthquakes, electrical surges, and power outages. *Intentional Acts:* the actions of an individual or individuals who wish to damage, destroy, or alter the records.

Define wellness and holism

*Wellness* is often used interchangeably with good health, generally meaning an absence of disease or illness; however, in the context of this chapter, it includes much more. *Holism* first used in discussion of systems theory, is often defined as the totality or entirety of a system that is more than the sum of its parts. The system being looked at in health care is the human person.

Define alternative, complimentary, integrative

*Complementary and alternative health-care practices*, now called *integrative* practices, have been widely used by a large percentage of the population. Their popularity continues to increase dramatically with clients of all ages and backgrounds. Integrative practices include a range of traditional therapies and treatments that are not usually used or taught in conventional Western health care. Although some use the terms alternative health care and integrative health care synonymously, integrative care is more inclusive. It attempts to integrate the best of Western scientific medicine with a broader understanding of the nature of illness, healing, and wellness. It also includes complementary and alternative practices but goes beyond to include the care of the whole person, focusing upon health rather than illness.

Define data, information, and knowledge. Describe examples of each.

*Data* are defined as raw and unstructured facts. For example, the numbers 102 and 104 are raw data: By themselves, these numbers have little meaning because they lack interpretation. *Information* consists of data that have been given form and have been interpreted. If the numbers 102 and 104 are given additional descriptors so that they become a 25-year-old man with an oral temperature of 102°F and a heart rate of 104 beats per minute (bpm) taken on admission to the emergency room, they become information that has meaning to the nurse. *Knowledge* takes the process one step further because it is a synthesis of data and information. Knowing that an oral temperature of 102°F is higher than normal and a heart rate of 104 bpm is faster than normal for a 25-year-old man, and combining that information with an understanding of human physiology and pharmacology, the nurse is able to decide what treatment should be given.

Problem -solving and conflict resolution

-the nursing process is an excellent framework for problem resolution. It focuses on the goals of mutual interaction and communication to establish trust and respect. Using the process of assessment, analysis, planning, implementation, and evaluation helps the nurse organize and structure interpersonal interactions Conflict resolution: Problem-solving is often perceived as less emotional and more structured, whereas conflict management is considered to be more emotionally charged, with the potential to produce hostility. However, the steps of conflict management and problem-solving are almost identical to those of the nursing process. *The one additional element that must be included in conflict resolution is the ability to use assertive behaviors and communication when discussing the issues.*

Disaster planning

1. Get informed 2. Make a plan 3. Assemble a kit 4. Update the plan and the kit

Nursing process

1. Assessment 2. Diagnosis: Determines client problems, risks, and strengths 3. Planning: The nurse specifies short and long term outcomes for the client 4. Implementing 5. Evaluation: Reviews the client outcome, determines that it was not met, and modifies the interventions

System Elements

1. The system itself (i.e., whether it is open or closed) 2. Input and output 3. Throughput 4. Feedback loop

Breach of confidentiality

A breach of confidentiality results when a client's trust and confidence are violated by public revelation of confidential or privileged communications without the client's consent. Acceptable: -Patients ask you to inform a friend or relative of theirs about their condition -You share confidential information with other health professionals participating in the management of the patient.

List the steps in developing critical thinking

1. Gain insight and self-awareness: How do experts describe critical thinking? How do you personally describe it? How do your personality, learning style, and upbringing affect your thinking? What other factors influence thinking? What strategies help? (Chapter 1 addressed the first two questions; this chapter helps you answer the rest.) 2. Build trust in relationships and aim for mutual communication in all interactions. Skilled communication and open, honest exchange of facts, thoughts, ideas, and feelings is key. 3. Use an evidence-based reference to ensure that everyone in your group has a common understanding of what critical thinking entails. These guides serve as "talking points" to discuss what's going well and what needs to be improved. Everyone must be "on the same page." 4. Make the commitment to develop the attitudes, knowledge, and skills needed for critical thinking. 5. Ask for feedback—formal and informal evaluation related to your thinking and performance are crucial for improvement. You need to know what you're doing well and what you can do to improve.

The need for many more certified RN-coders and certified RN-auditors.

Because the changes are much more complicated, the knowledge and expertise of nurses will be a remarkable asset

Interdisciplinary Team (nursing contribution)

A coordinated group of experts from several different fields who work together toward a common nursing goal. Interdisciplinary teams work on a complex project that requires multiple skills sets or areas of expertise in order to succeed.

Culture

A group's acceptance of a set of attitudes, ideologies, values, beliefs, and behaviors that influence the way the members of the group express themselves Culture is defined and understood in several ways. It is a collective way of thinking that distinguishes one relatively large group from another over generations. For example, members of a political party, although diverse in other ways, may be viewed as belonging to a particular culture because of their beliefs and ideologies. These are often handed down from parents to children over generations. Cultural expression assumes many forms, including language; spirituality; works of art; group customs and traditions; food preferences; response to illness, stress, pain, bereavement, anger, and sorrow; decision-making; and even world philosophy.

Health surrogate

A health care surrogate is an adult who is appointed to make healthcare decisions for you when you become unable to make them for yourself. • appointed by the doctor or nurse if the doctor determines that you cannot make medical decisions yourself and there is no existing MPOA

How has the Affordable Care Act (ACA) impacted care to elderly?

A large segment of the older population expressed a sense of relief regarding their health-care options. Health care has become more accessible to those in need.

Code of Ethics

ANA- American Nurse Association A written list of a profession's values and standards of conduct. The code of ethics provides a framework for decision-making for the profession and should be oriented toward the daily decisions made by members of the profession. Does not provide specific answers

Why is heritage consistency important?

Allows people trying to acculturate to fit in and advance within the larger culture, while retaining many of the cultural elements that feel like home, which provides a sense of stability in their lives.

Verbal Communication Blockers

Anything done or said that interferes with communication is called a communication blocker. -close-ended questions -interupting -discouraging words Actions and speech that encourage and build communication are called communication builders

What impacts the ability of self-care and managing at care home?

As people age, the ability to perform activities of daily living often decrease if any type of illness occurs that impinges on their physical and/or mental function. It is evident that the majority of adults would prefer to reside in their own community and home as long as possible. Being in a familiar environment makes the older adult more apt to remain independent and have a sense of comfort and belonging. Often, when independence is removed from older adults, they do not have a family support system to help them. States that invest in home support services for the elderly have reduced the number of clients receiving long-term institutional care and overall spending in their Medicare programs

The roles of nurse navigator role

Attempts to eliminate barriers. Serves as an advocate for the client. Makes moving through the treatment phase easier. Similar to a case manager. Focuses on one specialty, like cancer. Helps reduce the client's anxiety and depression. Although the nurse navigator role is similar to the case manager, it tends to be more focused on only one specialty area, such as cancer clients. The role revolves around clients and families to help them deal with complex care issues. The nurse navigator attempts to eliminate barriers and serves as an advocate for the client to make moving through the treatment maze easier. Some of the obstacles that clients must face include lack of transportation, a myriad of confusing insurance forms, change in financial status, lack of knowledge about the disease and its treatment options, and the side effects of powerful medications.

Define ways a professional organization can impact nursing

By working together for a specific purpose, an association or organization amplifies its impact, and by developing a strategic plan, it focuses that impact to achieve certain results. Many professions have a single major professional organization to which most of its members belong and several specialized sub-organizations that members may also join. Professions with just one major organization generally have a great deal of political power. Maintains/Improves nursing education, Improves health care standards, Promotes professional growth and development, Establishes a code of ethics for nurses, Allows for research and expansion

How does chronic disease and co-morbid status impact elderly clients and nurses

Chronic disease affects the older population by decreasing their quality of life, which ultimately leads to higher cost of health care. Chronic conditions cause debilitation and pain. Effective public health strategies currently exist to help older adults remain independent longer, improve their quality of life, and potentially delay the need for long-term care. Elderly are living longer and it is costing more money and as more of the elderly seek health care, the nursing shortage will only become more pronounced

What term best describes personal opinions, results, decisions one makes

Clinical judgement

How do nurses prioritize changes in practice based on research

Comparative effectiveness research (CER): A method to determine the priority of research topics developed by the IOM, based on client outcomes both in and outside the institutional setting.

Knowledge creation

Continuous transfer, combination, and conversion of the different types of knowledge, as users practice, interact, and learn.

Energy: Conventional use, alternative use

Conventional use: screening, diagnosis, and some types of treatment; Alternative use: refer to energy systems as fields, vital essences, balance, and flow that clients can use to prevent illness, promote health, and heal themselves

Organ transplantation

Despite widespread public and medical acceptance of organ transplantation as a highly beneficial procedure, ethical questions still remain. Whenever a human organ is transplanted, many people are involved, including the donor, the donor's family, medical and nursing personnel, and the recipient and his or her family. Transplantation is the only health-care field in which actions taken by a group of medical professionals in one part of the country affect their counterparts in another part of the country. Society as a whole is affected by organ transplantation, mainly because of the high cost of the procedures, which usually are covered by federal funding from taxes or reimbursement from private insurance, which in turn increases insurance premiums. Whether it occurs on a popular medically oriented television series or in a movie where organ donation is the primary focus, the general public is exposed to organ donation more frequently now than in decades past. This popular exposure increases awareness of the need for organ donation and calls attention to people or groups of people who are affected by every aspect of donation and transplantation. Each one of these persons or groups has rights that may directly conflict with the rights of others.

DNR

Do not resuscitate, also known as no code or allow natural death, is a legal order written either in the hospital or on a legal form to withhold cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS), in respect of the wishes of a patient in case their heart were to stop

What are the attributes to describe critical thinking

Habitually inquisitive, self-informed, trustful of reason, open-minded, flexible, fair-minded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in selecting criteria, focused in inquiry, and persistent in seeking results that are as precise as the subject and the circumstances of inquiry permit

HIPPA

Health Insurance Portability and Accountability Act of 1996) is United States legislation that provides data privacy and security provisions for safeguarding medical information.

List the QSEN competencies and relationship to nursing education

Help guide what is being taught in nursing programs • Client-centered care • Teamwork and collaboration • Evidence-based practice (EBP) • Quality improvement (QI) • Safety • Informatics

Define nursing informatics

How the management and processing of information helps nurses enter, organize, or retrieve information. The content and application of nursing information is substantively different from that of other disciplines.

Nursing values

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

Alternative medicines and therapies

Include a range of traditional therapies and treatments that are not usually used or taught in conventional Western health care.

What is IOM and what have they concluded about quality?

Institute of Medicine the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." Its three accepted elements are structure, process, and outcome, while care should be safe, effective, client-centered, timely, efficient, and equitable. The Quality and Safe Education for Nurses (QSEN) project, built upon the IOM recommendations, is in the process of developing a framework for nursing schools' curricula

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

It has most recently been defined as "disruption in the life principle that pervades a person's entire being and integrates and transcends one's biological and psychosocial nature." examples: concerns with and questions about the meaning of life and death, anger toward God, concerns about the meaning of suffering, concerns about the person's relationship to God, the inability to participate in preferred religious practices, seeking spiritual help, concerns about the ethics of prescribed medical regimens, preoccupation with illness and death, expressing displaced anger toward clergy, sleep disturbances, and altered mood or behavior. these examples are characteristics that would define a diagnosis of spiritual distress

How does the Joint Commission on Accreditation of Healthcare Organization (JCAHO) measure healthcare organizations spiritual of elderly?

JCAHO established a standard of client care that includes spiritual and emotional care for clients. JCAHO states that the client's spiritual assessment is to include identification of spiritual practices important to them

Watson Health Care System Model

Jean Watson uses a philosophical approach about balance impersonal aspects of nursing care with personal and interpersonal elements of care that grow from humanistic belief in life. Spiritual beliefs as an essential element of health. Defines caring in a detailed and systematic manner using philosophical approach Client- Individual, the individuality of the client is a key concern Has needs, grows and develops to reach a state of inner harmony Health- Dynamic state of growth and development leading to full potential as a human being. To be healthy according to the Watson model, the individual must be in a dynamic state of growth and development that leads to reaching full potential as a human. Illness is the client's inability to integrate life experiences and the failure to achieve full potential or inner harmony. Environment- The client must overcome certain factors to achieve health. Viewed primarily as a negative element in the health-care process Nursing- Science of caring that helps clients reach their greatest potential

What are the common symbols of nursing?

Lamp, Nursing Pin, Cap 1. The Lamp: Pushing back darkness introduced by Florence Nightingale. It dispelled fear and allowed people to pursue learning long after the sun went down. 2. The Nursing Pin: origin is heavy shield back in the greek and roman empires to protect from weapons. Florence Nightingale-nursing excellence pin 3. The Cap: origin is to recognize those who care for the sick. The cap's primary purpose was to keep the nurse's long hair from getting in the way, but it also identified nurses who had graduated from what school.

Identify the principle upon which Nightingale's spirituality was based

Modern nursing has a rich legacy of the appreciation of spirituality in health and illness. Florence Nightingale's views of nursing practice were based on a spiritual philosophy that she set forth in Suggestions for Thought. She was the daughter of Unitarian and Anglican parents, and among her ancestors were famous dissenters against the Church of England. The skepticism fostered by her Unitarian upbringing may have influenced her to question and critique established religious doctrine. Her search for religious truth caused her to become familiar with the writings of Christian mystics (e.g., St. Francis of Assisi, St. John of the Cross) and also with various Eastern mystical writings, including the Bhagavad Gita. To her, the laws of nature and science were merely "the thoughts of God." Spirituality for Nightingale entailed the development of courage, compassion, inner peace, creative insight, and other "Godlike" qualities

Supplemental

Need for Healthcare Reform - Four broad categories—economic issues, societal issues, ethical/moral issues, and health outcome issues—delineate the need for health-care reform.

Know the individuals who played a key role in shaping modern day nursing. What were their contributions?

Nightingale, Robb, Wald, Ford 1. Florence Nightingale: founder of modern nursing, improving health care and nursing standards. Volunteer nurse during Crimean War. Opened Florence Nightingale School of Nursing and Midwifery in 1860 2. Isabel Adams Hampton Robb: Raising the standards of nursing education in the United States- grading policy for nursing students that required nurses to prove their abilities in order to be awarded a diploma. Johns Hopkins hospital, American Nurses Association (ANA) 3. Lillian Wald: The Henry Street Settlement, Metropolitan Life Insurance Company, American Red Cross's Town and Country Nursing Service and with initiating the concept of school nursing, she was the first to place nurses in public schools 4. Loretta C. Ford: Credited with founding nurse practitioner (NP) practice 5. Annie Goodrich: - started the army's first nursing school -began the nursing program at vassar college -served as dean of nursing at Yale 6. Lavinia Lloyd Dock: -wrote the first medication textbook for nurses -worked for social reform and women's right

Civil Laws

Nurses are much more likely to become involved in civil lawsuits than in criminal violations. Civil laws generally deal with the violation of one individual's rights by another individual. The court provides the forum that enables these individuals to have their disputes resolved by an independent third party, such as a judge or a jury of the defendant's peers. The individual who brings the dispute to the court is called the plaintiff. The formal written document that describes the dispute and the resolution sought is called the complaint. *Under which category are nursing licensure laws included*

How do nurses address the Older Population's Spirituality? What is spirituality?

Nurses must be committed to understanding and be able to assess the importance spirituality plays in elderly clients' daily lives, whether living at home, in a community setting, hospital, or long-term care facility When nurses provide spiritual support to any client during a time of illness, the client develops a sense of balance with the life he or she has lived. Nurses know how important it is for the elderly to be comfortable physically, but they also need to take into consideration their spiritual needs. Using spiritual strategies improves the individual's self-esteem and relationships with others and with God. These strategies include using empathy and open-ended questions such as, "What you've been saying indicates that you are distressed about your condition. Have you given any thought to why it has happened to you?" or allowing the client to vent religious or spiritually oriented concerns, and supporting the client's spirituality by promoting the use of prayer and scripture, encouraging family to participate in rituals and prayers, or helping the client understand the etiologies of spiritual distress as they work through the grieving process. Using these strategies will help elderly clients find meaning and hope in their lives.

Developing cultural awareness starts where?

Nurses must first understand their own cultural backgrounds and explore the origins of their own potentially prejudiced and biased views of others. Cultural awareness begins with an understanding of one's own cultural values and health-care beliefs.

How do nurses change their practice

Nurses must promote an environment conducive to change. In many hospitals, maintaining the status quo often appears to carry incentives that may intimidate even the most intuitive and confident change agent. The professional nurse committed to using "best evidence" to provide the best client care can be most effective by finding simple approaches that create an environment receptive to new research findings. Some helpful tactics include: • Reading clinical journals regularly but also critically. Nursing professionals are well informed and believe in the concept of lifelong learning. • Attending clinically focused nursing conferences where the latest client-care interventions are presented and discussed. • Learning to look for evidence that clearly supports the effectiveness and the feasibility of updating nursing interventions. • Seeking work environments that promote the use of research findings and evidence-based care. • Collaborating with a nurse researcher. Apprenticeship to one who masters a skill is an old but venerated means of learning that skill. • Learning to critically scrutinize the status quo. Many worthwhile ideas for change come from those students and nurses "in the trenches" and at the bedside. • Pursuing the possibility of proposing and implementing a project. If the nurse finds a research-based idea for clinical care interesting, then taking the steps to research it can be productive.

Define the roles of and practice setting

Nursing roles evolve and develop in response to the needs of society.

Beneficence

One of the oldest requirements for health-care providers, views the primary goal of health care as doing good for clients under their care. In general, the term good includes more than providing technically competent care for clients. Good care requires that the health-care provider take a holistic approach to the client, including the client's beliefs, feelings, and wishes, as well as those of the client's family and significant others. The difficulty in implementing the principle of beneficence is in determining what exactly is good for another and who can best make the decision about this good

Value System

One's value system is molded by one's virtues or vices. A person's standards and self-discipline set, based on the common sense and wisdom of knowing what the proper moral rules and discipline are, and the amount of willingness to see themselves and others abide by them.

Problem Etiology Signs Statement (PES)

Problem related to etiology as evidence by sign or symptom • Problem: any problem or risk either stated by the patient or id by the nurse • Etiology: suggests a possible cause of that stated problem • Sign or symptom: subjective and objective clues that indicate and support the presence of the problem

Understand the difference between quality improvement and quality assurance. What is meant by "quality"?

Quality - the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. • Quality Improvement - proactively oriented so that emphasis is placed on anticipating and preventing problems rather than reacting to them after the fact. • Quality Assurance - attempts to guarantee action is performed by health care professional and performed correctly the first time and each time after. Actions and activities are always measured & compared to a standard of care.

Identify roles of various nursing specialties listed in this chapter

RN: responsible in implementing the medical plan of care given by the physician and the nursing care plan made by the nursing staff. Associates or bachelors LPN: Similar to Registered Nurses, LPNs implement both medical and nursing plans for the residents but with the supervision of the RN. Vocational CNA: provides care and carry out duties with the supervision of a Registered Nurse or Licensed Practical Nurse. State exam CNS: usually hired by hospitals and often function as in-service educators for the hospital. Masters CNL: generalist with a master's degree who can coordinate care for clients, use EBP in care, focus on quality improvement, and oversee risk management and client safety. Masters ARNP: often provide primary health-care services in areas where there is a lack of primary care physicians. Masters DNP: All ARNP should transfer to by 2015. Doctorate

Role of nursing case managers

Registered nurses (RNs) who develop, implement, and evaluate individualized patient care plans. They act as social workers, advocate patient welfare, and serve as a liaison between patients, their families, and healthcare providers. Includes overseeing the client's care while they are in the hospital and following them through their rehabilitation at home, long-term follow-up, health-care practices, and developmental stages.

Distinguish between spirituality and religion

Religion can be an approach to or expression of spirituality, and spirituality is a component of religion. - A religious perspective often entails a set of beliefs, or a creed, that helps explain the meaning of life, suffering, health, and illness.

Laws

Rules of social conduct made by humans to protect society, and these laws are based on concerns about fairness and justice. The goals of laws are to preserve the species and promote peaceful and productive interactions between individuals and groups of individuals by preventing the actions of one citizen from infringing on the rights of another. 1. Enforceable through some type of police force 2. Applied equally to all persons.

SBAR

Situation Background Assessment Recommendation a technique that can be used to facilitate prompt and appropriate communication.

Ethical Dilemma

Situation that requires an individual to make a choice between two equally unfavorable alternatives. The basic, elemental aspects of an ethical dilemma usually involve conflict of one individual's rights with those of another, conflict of one individual's obligations with the rights of another, or combined conflict of one group's obligations and rights with those of another group. No simple correct solution

Define spirituality

Spirituality is often defined as integrative energy, capable of producing internal human harmony, or holism. Other definitions refer to spirituality as a sense of coherence. Spirituality also entails a sense of transcendent reality, which draws strength from inner resources, living fully for the present, and having a sense of inner knowing. Solitude, compassion, and empathy are important components of spirituality for many individuals.

What are four main elements of consideration for evaluating critical thinking

The 4-Circle CT Model above gives "a picture" of what it takes to think critically. Going clockwise, here's what you need to do (1) Develop critical thinking characteristics and behaviors. When someone has critical thinking characteristics, the skills in the other circles come readily. (2) Acquire theoretical and experiential knowledge, as well as intellectual skills related to nursing process (e.g., assessing systematically and setting priorities). (3) Gain interpersonal and self-management skills. For example, learn how to resolve conflicts and engage patients in care; learn how to manage your emotions, stress, and time. (4) Expand your technical skills. When you don't have the related technical skills—for example, IVs, nasogastric tubes, computer skills—you have less brain power for critical thinking (because of the "brain-drain" of learning technical skills)

Supplements; regulation of supplements

The FDA defines dietary supplements as "a product intended for ingestion that contains a 'dietary ingredient' intended to add further nutritional value to (supplement) the diet. A 'dietary ingredient' may be one, or any combination, of the following substances: • A vitamin • A mineral • An herb or other botanical • An amino acid • A dietary substance for use by people to supplement the diet by increasing the total dietary intake • A concentrate, metabolite, constituent, or extract Dietary supplements may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. Some dietary supplements can help ensure that you get an adequate dietary intake of essential nutrients; others may help you reduce your risk of disease." Regulation: Concern about nutritional supplements also exists because, unlike drugs and most food additives, they are not regulated by the FDA. If manufacturers make no claims that they are effective against a disease, they do not need to be tested for safety and effectiveness before they are sold to the public. The FDA can remove supplements from the market if it receives reports of their adverse effects and then proves that they are dangerous to consumers' health.

Roy Adaptation Model: (Understand the 3 stimuli in this theory)

The Roy Adaptation Model's definition of environment is synonymous with the concept of stimuli. The environment consists of all those factors that influence the client's behavior, either internally or externally. This model categorizes these environmental elements, or stimuli, into three groups: 1. focal: environmental factors that most directly affect the client's behavior and require most of his or her attention 2. contextual: form the general physical, social, and psychological environment from which the client emerges. 3. residual: factors in the client's past, such as personality characteristics, past experiences, religious beliefs, and social norms, that have an indirect effect on the client's health status. Residual stimuli are often very difficult to identify because they may remain hidden in the person's memory or may be an integral part of the client's personality.

Critical Thinking

The ability to recognize problems and raise questions, gather evidence to support answers and solutions, evaluate alternative solutions, and communicate effectively with others to implement solutions for the best possible outcomes.

Meta-Ethics

The abstract, overarching philosophical way of understanding ethics. One of the most important questions that philosophy in general addresses is the question of epistemology, or how we know that we know. In ethics, this question is refined to how do we know what is right and wrong. It also seeks to answer the question, "What is truth?" It is concerned with the meaning of ethical language and explaining the fundamental meaning of the words. The discussion below of the ethical terms is actually a meta-ethics approach to understanding ethics. Without meta-ethics, it is almost impossible to take the next step to normative ethics.

Applied Ethics

The application of the theories and systems of ethics developed by normative ethics to real-world situations. Applied ethics is broken into specialized fields such as health-care ethics, legal ethics, bioethics, or business ethics. This is the category of ethics that is used most by nurses and other health-care providers. It is used in resolving ethical dilemmas.

How are clients impacted by Health-Care Coverage (review following)

The expenses are expected to multiply faster than the national inflation rate for the foreseeable future. Employers are faced with a growing need to increase their expenditures in premiums for family coverage for their employees, and as a result, they are hiring more part-time employees who are not required to be covered. Although the trend in rising unemployment has started to reverse slightly in recent years, many individuals are overqualified for the work and or these jobs are still at the lower end of the pay scale, which leads to an overall lower income for middle-class Americans. As a result, there is greater government health-care spending through the Medicaid program, which covers low-income families

Why is biological/physical cultural variations important?

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

Fidelity

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

Justice

The obligation to be fair to all people. The concept is often expanded to what is called distributive justice, which states that individuals have the right to be treated equally regardless of race, gender, marital status, medical diagnosis, social standing, economic level, or religious belief.

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

The primary skills required for cultural competence include communication, understanding, and sensitivity. Although the basic types of cultural skills are similar, their application within and between cultural groups may differ greatly. The development of cultural competence is not a one-time skill to check off on a skills checklist; rather, it is an ongoing process that continues throughout the nurse's career. A nurse develops cultural awareness only when he or she is able to recognize and value all aspects of a client's culture, including beliefs, customs, responses, methods of expression, language, and social structure. However, merely learning about another person's culture does not guarantee that the nurse will have cultural awareness.

Nonmaleficence

The requirement that health-care providers do no harm to their clients, either intentionally or unintentionally. The principle of nonmaleficence also requires that health-care providers protect from harm those who cannot protect themselves.

Normative Ethics

The use of the concepts and principles discovered by meta-ethics to guide decision-making about specific actions in determining what is right or wrong when interacting with other people. Normative ethics tends to be more prescriptive than meta-ethics and forms the basis for theories and systems of ethics (below). Both the codes of ethics and the deontological ethical system (below) find their underpinnings in meta-ethics and normative ethics

Define the term healing, medicine, holism

The use of the term healing is preferred to medicine. Integrative health care and alternative and complementary modalities typically are based in holistic philosophies, which go beyond treatment or cure of the physiological and psychological dimensions of care commonly associated with modern, scientific biomedicine. Holism refers to treatment of the whole person (body-mind-spirit) in that person's environmental context (i.e., physical, biological, social, cultural, and spiritual).

Define therapeutic touch

Therapeutic touch (TT) is an active alternative healing modality that involves redirecting the human energy system. The practitioner of TT acts with the intent of relaxing the recipient, reducing pain and discomfort, and accelerating healing when appropriate. Early controlled studies showed that the hemoglobin levels of a group of clients who received TT increased significantly more than the levels in a control group who did not receive TT.

Understand timeouts

Time-outs, in which the entire team stops to become focused and on the same plan of care are used to prevent errors. There are two kinds of time-outs. One is routine, such as at the beginning of surgeries, when patients' identities and surgical procedures are double- and triple-checked. The other type of time-out is spontaneous. If at any time any team member—nurse, nursing aid, respiratory therapist (RT), or physician—recognizes an actual or potential risk for harm to the patient, he or she is responsible for calling a time-out and pointing out the concern (the rest of the team is accountable for listening and deciding how to address it).

Health Care Systems in the Western World (Types 1-4)

Type 1: Private health insurance (preserve autonomy & acceptance of social differences) Type 2: National health insurance (egalitarian & preserve autonomy) - uses tax dollars Type 3: National health service (egalitarian & public management) -operated by the government Type 4: Socialized health system (essential service & physicians as state employees)

How does Research get to Evidence-Based Practice

Using research is essential to improving quality of care for clients. In the 1970s, research became a formal part of educational institutions. In the 1990s, evidence-based medicine (EBM) or evidenced-based health care (EBHC) became the gold standard for physician care. It was the active application of the current best evidence to make the optimal decisions about the treatment of individual clients using statistical data to estimate the risk-benefit ratio that was supported by high-quality research on population samples.

Describe the human factor. What areas need to be addressed when developing technology?

When information tools, machines, and systems are developed, they must include recognition of human factors, including knowledge about human capabilities, limitations, and characteristics that may affect the use of the system. The study of human factors examines how to make the interaction of people and equipment safe, comfortable, and effective. Cognitive science, one of the components of informatics discussed earlier, forms part of the foundation for the study of human factors. Cognitive science includes the human acts of perception, thinking, understanding, and remembering.

Crises

a time of intense difficulty, trouble, or danger

Communicative styles and how they impact communication with co-workers, administration and patients

assertive, nonassertive, and aggressive • Assertive: the preferred style in most settings. It involves interpersonal behaviors that permit people to defend and maintain their legitimate rights in a respectful manner that does not violate the rights of others. Assertive communication is honest and direct and accurately expresses the person's feelings, beliefs, ideas, and opinions. It encourages trust and teamwork by communicating to others that they have the right to and are encouraged to express their opinions in an open and respectful atmosphere. Disagreement and discussion are considered to be a healthy part of the communication process, and negotiation is the positive mechanism for problem-solving, learning, and personal growth. • Nonassertive (submissive): When people display submissive behavior or use a submissive communication style, they allow their rights to be violated by others. Their requests and demands are surrendered to others without regard to their own feelings and needs. Many experts believe that submissive behavior and communication patterns are a protective mechanism that helps insecure people maintain their self-esteem by avoiding negative criticism and disagreement from others. In other situations, it may be a means of manipulation by way of passive-aggressive behavior. Submissive communicators dismiss their own feelings as being unimportant. Rather than being in control of the communication or relationship, the person is trading his or her ability to choose what is best for the avoidance of conflict. • Aggressive: (assertive communication permits individuals to honestly express their ideas and opinions while respecting the other's rights, ideas, and opinions) Aggressive communication strongly asserts the speaker's legitimate rights and opinions with little regard or respect for the rights and opinions of others. It easily becomes a communication blocker. Aggressive communication—used to humiliate, dominate, control, or embarrass the other person or lower that person's self-esteem—creates an "I win, you lose" situation. The other person may perceive aggressive behavior or communication as a personal attack. Aggressive behavior and communication are viewed by some psychologists as a protective mechanism that compensates for a person's own insecurities, and others view it as a form of bullying. Screaming, sarcasm, rudeness, belittling jokes, and even direct personal insults

Delegation

designating ancillary personnel for the responsibility of carrying out a specific group of nursing tasks in the care of certain clients. Delegation includes the understanding that the authorized person is acting in the place of the RN and will be carrying out tasks that generally fall under the RN's scope of practice.

Reimbursement Systems

obtaining payment for service

What is telehealth/telemedicine and what is the purpose?

the use of electronic information and communications technologies to provide and support health care when distance separates the physician and the client. Telehealth includes a wide range of services and technologies, from "plain old telephone service" (POTS) to highly sophisticated digitized cameras, telemetry, voice systems, and even interactive robots that can be controlled by the practitioner to assess clients. Telemedicine is just one of the services provided by the overall telehealth system that primarily involve consultation with a physician. Telehealth is being used in emergency departments (EDs) across the United States. The University of Pittsburgh offers neurological consultations to physicians at seven linked hospitals. In Baltimore, providers are using cellular telephone technology to transmit live video and client data back to home base. Some uses of telehealth, such as emergency calls to 911, are so common that they are often overlooked as part of telehealth systems. Other applications, such as telesurgery, involve advanced technologies and procedures that are being used on a limited basis and are still considered experimental.

Patient Self-Determination Act

this legislation required many hospitals, nursing homes, home health agencies, hospice providers, health maintenance organizations (HMOs), and other health care institutions to provide information about advance health care directives to adult patients upon their admission to the healthcare facility.

Define evidence-based practice

• "Evidence-based practice is the practice of nursing in which interventions are based on data from research that demonstrates that they are appropriate and successful." • It involves a systematic process of uncovering, evaluating, and using information from research as the basis for making decisions about and providing client care.

Speak to patient safety

• *S*peak up if you have questions or concerns, and if you don't understand, ask again. It's your body, and you have a right to know. • *P*ay attention to the care you are receiving. Make sure you're getting the right treatments and medications by the right health care professionals. Don't assume anything. • *E*ducate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan. • *A*sk a trusted family member or friend to be your advocate. • *K*now your medications and why you take them. Medication errors are the most common health care errors. • *U*se a hospital, clinic, surgery center, or other type of health care organization that has undergone a rigorous on-site evaluation against established state-of-the-art quality and safety standards, such as that provided by The Joint Commission. • *P*articipate in all decisions about your treatment. You are the center of the health care team.

Workplace bullying

• A type of incivility that is one step beyond impoliteness. It can be defined as any behavior that could reasonably be considered humiliating, intimidating, threatening, or demeaning to an individual or group of individuals. In the U.S. legal system, physical abuse, emotional abuse, verbal abuse, or any combination of the three are considered bullying and may be punished by fines in the civil system or jail time in the criminal system

Review examples of ways a nursing license may be revoked

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

Identify the history, development, and key characteristics of the various nursing degrees and certifications in this chapter

• Diploma schools: when nurses graduated from this school, they were given a certificate or diploma noting their graduation, but no academic degree. • These were also diploma schools: the US was behind Europe • Each hospital had its own school of nursing • Schools became accredited and then moved into universities

Horizontal and vertical violence

• Horizontal violence (when the dictator is of the same authority level) also known as lateral violence, has many of the same characteristics as bullying except that it takes place almost exclusively in the work setting. Lateral violence can be either covert or overt. Overt lateral violence can include name calling, threatening body language, physical hazing, bickering, fault finding, negative criticism, intimidation, gossip, shouting, blaming, put-downs, raised eyebrows, rolling of the eyes, verbally abusive sarcasm, or physical acts such as pounding on a table, throwing objects, or shoving a chair against a wall. Covert lateral violence is initially more difficult to identify and includes unfair assignments, marginalizing a person, refusing to help someone, ignoring someone, making faces behind someone's back, refusing to work with certain people, whining, sabotage, exclusion, and fabrication. • Vertical violence (bullying from a superior) is a type of harassment that can permeate the entire organization and have a detrimental effect on its effectiveness. The concept of inappropriate use of coercive power becomes a key element in vertical violence.

Know key significant events in history that contributed to shaping professional nursing

• In ancient Eastern civilizations, starting from about 3500 BC, health care was intertwined with religion. Taoism emphasized balance and the driving of demons out of the ailing body. • Hippocrates was called "the father of medicine." His beliefs focused on harmony with the natural law instead of on appeasing the gods. He emphasized treating the whole client—mind, body, spirit, and environment—and making diagnoses on the basis of symptoms rather than on an isolated idea of a disease. • The Dark Ages, from roughly AD 500 to 1000, were marked by widespread poverty, illness, and death. Plagues and other diseases such as smallpox, leprosy, and diphtheria ravaged the known world and killed large segments of populations. Health care at this time was almost nonexistent. • Holy wars and invasions, including the Crusades, which produced many sick and injured who were far from home. Military nursing orders developed to care for the soldiers • Technological advancements both solve and create problems. Nurses have proven themselves to be highly resourceful in dealing with issues related to technology. • The Great Depression took its toll on health care and nursing, as jobs became scarce and many nursing schools closed.

Factors that interfere with communication

• On the sender's side, these can be factors such as unclear speech, convoluted and confused message, monotone voice, poor sentence structure, inappropriate use of terminology or jargon, or lack of knowledge about the topic. • On the receiver's side, factors that may interfere with encoding include lack of attention, prejudice and bias, preoccupation with another problem, or even physical factors such as pain, drowsiness, or impairment of the senses.

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

• Professional unity: nurses are demonstrating their power to achieve a goal when they band together and exert power as a group • Becoming involved in political action. • Demonstrating the characteristics of accountability and professionalism. • Establishing a nurse support network.

How do you measure pain?

• Scale of 1-10, 10 being the worst- adult • Use Wong-Baker (facial scale) on child • Infants will be crying

Be familiar with the developmental stages of human spirituality

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

Identify why it is important for nurses to join professional organizations

• Strength in number • Speaking with one voice

Why has the use of integrative health practices increased?

• dissatisfaction with conventional health care • a desire for greater control over one's health • a desire for cultural and philosophical congruence with personal beliefs about health and illness.