CHAPTER 1: INTRODUCTION TO NURSING

Code of Ethics

Philosophical ideals of right and wrong that define the principles you will use to provide care to your patients

Component of excellence in practice is:

Quality of care, which is achieved by implementing evidenced-based practice

ANA Standards of Professional Performance Education

RN attains knowledge and competency that reflects current nursing practice

ANA Standards of Professional Performance Collaboration

RN collaborates with health care consumer, family, and others in the conduct of nursing practice

ANA Standards of Professional Performance Communication

RN communicates effectively in all areas of practice

ANA Standards of Professional Performance Quality of Practice

RN contributes to quality nursing practice

ANA Standards of Professional Performance Leadership

RN demonstrates leadership in the professional practice setting and the profession

ANA Standards of Professional Performance Professional Practice Evaluation

RN evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statuses, rules, and regulations

ANA Standards of Professional Performance Evidence-Based Practice and Research

RN integrates evidence and research findings into practice

ANA Standards of Professional Performance Ethics

RN practices ethically

ANA Standards of Professional Performance Environmental Health

RN practices in an environmental safe and healthy manner

ANA Standards of Professional Performance Resources

RN uses appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible

Magnet Recognition

Recognizes excellence in nursing practice

20th Century Movement toward developing a:

Scientific, researched-based defined body of nursing knowledge and practice evolved

Genetics

Study of inheritance, or way traits are passed down from one generation to another

Standards of Professional Performance

- ANA Standards of Professional Performance describe a competent level of behavior in the professional role - Standards provide a method to assure patients that they are receiving high-quality care, that the nurses must know exactly what is necessary to provide nursing care, and that measures are in place to determine whether nursing care meets the standards

Certified Nurse-Midwife (CNM)

- APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwives - Involves providing independent care for women during normal pregnancy, labor, and delivery and care for the newborn - Includes some gynecological services such as routine Papanicolaou (Pap) smears, family planning, and treatment for minor vaginal infections

Clinical Nurse Specialist (CNS)

- APRN who is an expert clinician in a specialized area of practice - Speciality may be identified by a population, setting, disease speciality, type of care, or type of problem - Ex: community, acute care, restorative, and palliative

Civil War to the Beginning of the 20th Century Nursing in community did not increase significantly until 1893, when:

- Lillian Ward and Mary Brewster opened the Henry Street Settlement - Focused on the health needs of poor people who lived in tenements in NYC

Safety

- Minimize risk of harm to patients and providers through both system effectiveness and individual performance - Ex: examine human factors and basic safety design principles and commonly used unsafe practices; value own role in preventing errors

Advanced Practice Registered Nurse (APRN)

- Most independently functioning nurse - Has advanced education in pathophysiology, pharmacology, and physical assessment and certification and expertise in a specialized area of practice - Function as clinicians, educators, consultants, and researchers

Manager

- Nurse managers need to establish an environment for collaborative patient-centered care to provide safe, quality care with positive patient outcomes - Manager coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency - Uses appropriate leadership styles to create a nursing environment for patients and staff that reflects the mission and values of the health care organization

Civil War to the Beginning of the 20th Century Mother Bickerdyke

- Organized ambulance services - Walked abandoned battlefields at night looking for wounded soldiers

QSEN initiative encompasses the competencies of:

- Patient-centered care - Teamwork and collaboration - Evidence-based practice - Quality improvement - Safety - Informatics

Patient Advocate

- Protect your patient's human and legal rights and provide assistance in asserting these rights if they arise - Act on behalf of your patient and secure your patient's health care rights - May need to defend patients' rights to make health care decisions in a general way by speaking out against policies or actions that put patients in danger or conflict with their rights

Patient-Centered Care

- Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs - Ex: involve family and friends in care; elicit patient values and preferences; provide care with respect for diversity of the human experience

Compassion Fatigue

- Term used to describe a state of burnout and secondary traumatic stress - Occurs without warning - Often results from giving high levels of energy and compassion over a prolonged period to those who are suffering, often without experiencing improved patient outcomes - Typically results in feelings of hopelessness, decrease in ability to take pleasure from previously enjoyable activities, state of hyper-vigilance, and anxiety

Six professional responsibilities and roles of a nurse:

1. Autonomy and accountability 2. Caregiver 3. Advocate 4. Educator 5. Communicator 6. Manager

Four core roles for the APRN:

1. Clinical nurse specialist (CNS) 2. Certified nurse practitioner (CNP) 3. Certified nurse midwife (CNM) 4. Certified RN anesthetist (CRNA)

Ten ANA Standards of Professional Performance:

1. Ethics 2. Education 3. Evidence-Based Practice and Research 4. Quality of Practice 5. Communication 6. Leadership 7. Collaboration 8. Professional Practice Evaluation 9. Resources 10. Environmental Health

Nursing Process

Foundation of clinical decision making and includes all significant actions taken by nurses in providing care to patients

Using genomic information allows health care providers to determine how:

Genomic changes contribute to patient conditions and influence treatment decisions

Civil War to the Beginning of the 20th Century Civil War stimulated:

Growth of nursing in the United States

ACA impacts:

How and where nursing care is provided

Affordable Care Act (ACA) affects:

How health care is paid for and delivered

Health care organizations can show their commitment to each health care stakeholder (ex: patients, insurance companies, and governmental agencies) to reduce health care errors and improve patient safety by:

Implementing evidence-based practices

Nurse Practitioner (NP)

- APRN who provides health care to a group of patients, usually in an outpatient, ambulatory care, or community-based setting - Provide care for patients with complex problems and a more holistic approach than physicians - Provides comprehensive care, directly managing the nursing and medical care of patients who are healthy or who have chronic conditions

Certified Registered Nurse Anesthetist (CRNA)

- APRN with advanced education from a nurse anesthesia-accredited program - Before applying to a nurse anesthesia program, nurse must have at least ONE YEAR of critical care or emergency experience - Provide surgical anesthesia under the guidance and supervision of an anesthesiologist

Civil War to the Beginning of the 20th Century Harriet Tubman

- Active in Underground Railroad - Helped to lead over 300 slaves to freedom

Autonomy and Accountability

- Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders - With increased autonomy comes greater responsibility and accountability - Accountability means that you are responsible professionally and legally for the type and quality of nursing care provided

20th Century Mary Adelaide Nutting

- Became first nursing professor at Columbia's Teacher's College in 1906 - Instrumental in moving nursing education into universities

Burnout

- Condition that occurs when perceived demands outweigh perceived resources - State of physical and mental exhaustion that often affects health care providers because of the nature of their work environment

Standards of Practice

- Describe a competent level of nursing care - Levels of care are demonstrated by a critical thinking model known as the nursing process (assessment, diagnosis, outcomes identification and planning, implementation, and evaluation)

Communicator

- Effectiveness is central to the nurse-patient relationship - Allows you to know your patients, including their strengths, weaknesses, and needs - Without clear communication, it is impossible to advocate for your patients or to give comfort and emotional support, give care effectively, make decisions with patients and families, protect patients from threats to well-being, coordinate and manage patient care, assist patients in rehabilitation, or provide patient education - Quality communication is a critical factor in meeting the needs of individuals, families, and communities

Florence Nightingale

- Established first nursing philosophy based on health maintenance and restoration - Saw role of nursing as having "charge of somebody's health" based on the knowledge of "how to put the body in such a state to be free of disease or to recover from disease" - Developed first organized program for training nurses, the Nightingale Training School for Nurses at St. Thomas' Hospital in London - First practicing nurse epidemiologist - Statistical analyses connected poor sanitation with cholera and dysentery - Known as "lady with the lamp" -- volunteered during Crimean War in 1853 and traveled the battlefield hospitals at night carrying her lamp - Tasked with organizing and improving the quality of sanitation at battlefield hospitals -- resulted in mortality rate at Barracks Hospital in Scutari, Turkey, was reduced from 42.7% to 2.2% in 6 months

Educator

- Explain concepts and facts about health, describe reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient's progress in learning - Always use teaching methods that match your patient's capabilities and needs and incorporate other resources, such as the family, in teaching plans

Civil War to the Beginning of the 20th Century Mary Mahoney

- First professionally trained African-American nurse - Concerned with effect culture had on health care - Noted as a nursing leader, she brought forth an awareness of cultural diversity and respect for the individual, regardless of background, race, color, or religion

Civil War to the Beginning of the 20th Century Clara Barton

- Founded American Red Cross - Tended to soldiers on battlefields, cleansing wounds, meeting basic needs, and comforting death

Teamwork and Collaboration

- Function effectively within nursing and inter professional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care - Ex: recognize the contributions of other health team members and patient's family members; discuss effective strategies for communicating and resolving conflict; participate in designing methods to support effective teamwork

Emotional Exhaustion

- Giving oneself in often intense caring environments leaving a nurse feeling irritable, restless, and unable to focus and engage with patients - Often occurs in situations where there is a lack of social support, organizational pressures influencing staffing, and inability of nurse to practice self-care

Caregiver

- Help patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process - Provide healing through psychomotor and interpersonal skills; more than achieving improved physical well-being - Need to meet all health care needs of a patient by providing measures to restore a patient's emotional, spiritual, and social well-being - Help patients and families set realistic goals and meet them

Current philosophies and definitions of nursing have a ___ focus, which addresses the needs of:

- Holistic - The whole person in all dimensions, in health and illness, and in interaction with the family and community

Quality and Safety Education for Nurses (QSEN)

- Initiative to respond to reports about safety and quality patient care by the IOM - Addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments

Evidence-Based Practice

- Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care - Ex: demonstrate knowledge of basic scientific methods; appreciate strengths and weaknesses of scientific bases for practice; appreciate importance of regularly reading relevant journals

Quality Improvement

- Use data to monitor outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems - Ex: use tools such as flow charts and diagrams to make process of care explicit; appreciate how unwanted variation in outcomes affects care; identify gaps between local and best practices

Informatics

- Use information and technology to communicate, manage knowledge, mitigate error, and support decision making - Ex: navigate an electronic health record; protect confidentiality of protected health information in electronic health records

Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples? (Select all that apply.) A. Caregiver B. Autonomy and accountability C. Patient advocate D. Health promotion E. Lobbyist

A. Caregiver B. Autonomy and accountability C. Patient advocate D. Health promotion

The nurse spends time with the patient and family reviewing the dressing change procedure for the patient's wound. The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role? A. Educator B. Advocate C. Caregiver D. Case manager

A. Educator

Health care reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform? A. Moving from an acute illness to a health promotion, illness prevention model B. Moving from an illness prevention to a health promotion model C. Moving from an acute illness to a disease management model D. Moving from a chronic care to an illness prevention model

A. Moving from an acute illness to a health promotion, illness prevention model

A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with them. The nurse is acting as the patient's: A. Educator B. Advocate C. Caregiver D. Case manager

B. Advocate

Which of the following Internet resources can help consumers compare quality care measures? (Select all that apply.) A. WebMD B. Hospital care C. Magnet Recognition Program D. Hospital Consumer Assessment of Healthcare E. The American Hospital Association's webpage

B. Hospital care D. Hospital Consumer Assessment of Healthcare

20th Century As nursing education developed, nursing practice also expanded, and the ___ and ___ ___ ___ were establish

Army and Navy Nurse Corps

Political Power/Influence

Ability to influence or persuade an individual holding a government office to exert the power of that office to affect a desired outcome

Shortage of nursing affects:

All aspects of nursing, including patient care, administration, and nursing education

20th Century When did nursing specialization begin?

By the 1920s

An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, listens to her lung and heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed? A. Diagnosis B. Evaluation C. Assessment D. Implementation

C. Assessment

Nurses in an acute care hospital are attending a unit-based education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education? A. Continuing education B. Graduate education C. In-service education D. Professional Registered Nurse Education

C. In-service education

A nurse meets with the registered dietitian and physical therapist to develop a plan of care that focuses on improving nutrition and mobility for a patient. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? A. Patient-centered care B. Safety C. Teamwork and collaboration D. Informatics

C. Teamwork and collaboration

Genes

Carry instructions for making proteins

Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing:

Compassion fatigue

Nurse Researcher

Conducts evidence-based practice and research to improve nursing care and further define and expand the scope of nursing practice

You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient with terminal cancer. As part of the preparation you have your classmates read the Nursing Code of Ethics for Professional Registered Nurses. Your instructor asks the class why this document is important. Which of the following statements best describes this code? A. Improves self-health care B. Protects the patient's confidentiality C. Ensures identical care to all patients D. Defines the principles of right and wrong to provide patient care

D. Defines the principles of right and wrong to provide patient care

A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed? A. Planning B. Evaluation C. Assessment D. Implementation

D. Implementation

A critical care nurse is using a computerized decision support system to correctly position her ventilated patients to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? A. Patient-centered care B. Safety C. Teamwork and collaboration D. Informatics

D. Informatics

The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career? A. Clinical nurse specialist B. Nurse administrator C. Nurse educator D. Nurse researcher

D. Nurse researcher

The examination for registered nurse (RN) licensure is exactly the same in every state in the United States. This examination: A. Guarantees safe nursing care for all patients B. Ensures standard nursing care for all patients C. Ensures that honest and ethical care is provided D. Provides a minimal standard of knowledge for an RN in practice

D. Provides a minimal standard of knowledge for an RN in practice

Proteins

Direct the activities of cells and functions of the body that influence traits such as hair and eye color

When communities face health care crises such as disease outbreaks or insufficient health care resources, nurses:

Establish community-based immunization and screening programs, treatment clinics, and health promotion activities

20th Century Nurses began to assume:

Expanded and advanced practice roles

Civil War to the Beginning of the 20th Century Nursing in hospitals expanded in:

Late 19th century

Compassion fatigue may contribute to what is described as:

Lateral violence

Nurse Administrator

Manages patient care and delivery of specific nursing services within a health care agency

Genomics

Newer term that describes the study of all genes in a person and interactions of these genes with one another and with that person's environment

21st Century Nurses and nurse educators are revising nursing practice and school curricula to meet:

The ever-changing needs of society, including an aging population, bioterrorism, emerging infections, and disaster management

Secondary Traumatic Stress

Trauma that health care providers experience when witnessing and caring for others suffering trauma

Nurse Educator

Works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments