Chapter 1 The profession of Nursing

National Student Nurses Association (NSNA)

-established in 1953 -goals are to contribute to nursing education to provide for the highest quality of healthcare; to provide programs representative of fundamental and current professional interests and concern. -aid in the development of the whole persin, his or her professional role for helthcare for all walks of life. -serves as a voice of nursing students speaking out on issues of concern to the entire profession.

Sigma Theta Tau Inernational, Honor Society of of Nursing

-founded in 1922 -headquartered in Indianapolis, Indiana -the Six nurse founders named the organization from the Greek words: Storge=love, Tharsos=courage, and Time=honor -membership is by invitation to students who demonstrate excellence in scholarship and to nurses in the community who demonstrate excellence in leadership

ANA's definition of nursing

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities and populations

Continuing Care: Nursing Centers or Facilities are regulated by whaich ACT?

Omnibus Budget Reconciliation Act of 1987

Lillian Walk and Mary Brewster

Opened the Henry Street Settlement, focusing on the health needs of the poor.

How do you Develope a PICOT question:

P = Patient population of interest I = Intervention of interest C = Comparison of interest O = Outcome T = Time

______________Links science, philosophy, and theories accepted and applied by a discipline

Paradigm

What are the 6 QSEN competencies?

Patient-Centered Care, Teamwork and Collaboration, Evidence-Based Practice, Quality Improvement, safety, Informatics

This type of care Serves patients recovering from an acute or chronic illness/disability Helps individuals regain maximal function and enhance quality of life Promotes patient independence and self-care abilities Requires multidisciplinary approach

Restorative Care: Home Care

Expert

This nurse no longer needs relies on rules or guidelines to connect understanding of a situation to an appropriate action. This nurse, with an enormous background of experience, has an intuitive grasp of the situation and zeroes in on the problem.

Proficent

This nurse perceives situations as a whole rather than in terms of aspects and manages nursing care rather than performing tasks.

Quality Improvement

Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of heath care systems. Examples: Use tools such as flow charts and diagrams to make process of care explicit. Appreciate how unwanted variation in outcomes affects care. Identify gaps between local and best practices.

Informatics

Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Examples: Navigate an electronic health record. Protect confidentiality of protected health information in electronic health records.

Linda Burnes Bulton

Vice Chair of Initiative on the Future of Nursing The Initiative identified solutions to the challenges faced by the nursing profession; and to improve the quality of and to transform how healthcare is delivered in the U.S.

This persons nursing theory was: Defines the outcome of nursing activity with regard to the humanistic aspects of life Purpose is to understand the interrelationships among health, illness, and human behavior.

Watson

Commission for Nursing Education Accreditation (CNEA)

a subsidiary of NLN. The main purpose of the NLN is to support nursing education with the goal of producing a well-prepared and diverse nursing workforce. -accredit practical nursing progroams; ADN, diploma, BSN, master's and doctoral programs

Explain compassion fatigue:

a term used to describe burnout and secondary traumatic stress, which impact the health and wellness of nurses and the quality of care provided to patients.

Accreditation commission for Education in Nursing (ACEN)

a third organization that provides accreditation services for nursing programs. Like CNEA, ACEN accredits nursing programs at all levels of education

What are the ANA Standards of Practice?

a. Assessment b. Diagnosis c. Outcomes Identification d. Planning e. Implementation f. Evaluation

Implementation

a. Coordination of care: The registered nurse coordinates care delivery. b. Health Teaching and Health Promotion: The registered nurse uses strategies to promote health and a safe environment. c. Consultation: The graduate level-prepared specialty nurse of advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change. d. Prescriptive Authority and Treatment: The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatment, and therapies in accordance with state and federal laws and regulations.

Identify the ANA Standards of Professional Performance.

a. Ethics b. Education c. Evidence-Based Practice and Research d. Quality of Practice e. Communication f. Leadership g. Collaboration h. Professional Practice Evaluation i. Resources j. Environmental Health

According to Benner, an expert nurse goes through five levels of proficiency. Identify them.

a. Novice b. Advanced Beginner c. Competent d. Proficient e. Expert

What are the external forces that have affected nursing practice in the twenty-first century?

a. Nurses' self-care b. Affordable care act (ACA) and rising health care costs c. Demographic changes of the population d. Human rights e. Increasing numbers of medically underserved

Identify the competencies of the QSEN initiative.

a. Teamwork and Collaboration b. Evidence-Based Practice c. Quality Improvement d. Safety e. Informatics

Advanced Practice Nursing

accelerated changes in healthcare with n emphasis on primary care. e.g. NP, CNS, nurse midwife, nurse anesthetist, nurse researcher, nurse administrator and nurse educator

Critical Forethough

anticipating likely immediate futures helps clinician make good plans and decisions about preparing the environment so that responding rapidly to change in the patient is possible.

Human needs

any physiologic or psychological factors necessary for a healthy existence. Most prominent theorist to focus on human needs has been Abraham Maslow.

Professional Nurses

are autonomous and assume the responsibilities of caregivers, patient advocates, educators, decision makers, managers and coordinators of healthcare needs, and communicators

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

assessment

In the nursing process, The gathering and analysis of information about the patient's health status, recording data from investigation reports is called?

assessment

_______________is used by nurses to show interest in what the client has to say, through active listening prompts such as "all right," "go on," or "uh-huh."

back channeling

Advanced Beginner

can Demonstrate marginally acceptable performance. He or She has had enough experience in actual situations to identify meaningful aspects or global characteristics that can be identified only through prior experience.

Nurse Educator

can be developed in many settings: schools of nursing and hospital staff development departments. usually need a Master's degree. -faculty in baccalaureate, master's or doctoral programs usually need a doctoral degree.

Acting as a ___________________, the nurse manages and cares for the health of a community.

care giver

This nurse role develops a caring partnership with patients to identify needed community resources.

caregiver

What are the 5 Professional roles as a nurse?

caregiver, advocate, educator, communicator, manager

This nurse role coordinates the activities of multiple providers in different health care settings.

case manager

The nurse who coordinates the resources and services needed for a patient's well-being across a continuum of care is referred to as a________________

case managercase manager

Acting as a ___________________, the nurse identifies and implements new approaches to solve a patient's problems

change agent

this nurse role identifies the quality of community child care services.

change agent

When the nurse protects the client's human and legal rights and provide additional information to help a client decide whether to accept a treatment they are acting as a_____________________

client advocate

Using the scientific method to solve nursing practice questions (need to know for exam)

clinical problem identify the problem collect data form research question to study the problem answer the question evaluate the results of the study

___________________is a process by which you seek the expertise of a specialist such as your nursing instructor, a physician, or a clinical nurse educator to identify ways to handle problems in patient management or in planning and implementation of therapies.

consultation

A ________________is a set of signs or symptoms grouped together in a logical way

data cluster

Conceptual Framework

describes ideas about individuals, groups, situations and events. -4 central concepts are the 1. person 2. environment 3. health 4. and nursing (Parker & smith)

In the nursing process, this phase is used to determine whether the interventions were effective. testing of the attainment of outcome goals. Determine if the patient met the expected patient outcome, NOT if nursing interventions were complete.

evaluation

True or False.... A nurse with a master's degree can participate in nursing research at all levels.

false

True or False....A nurse with a Bachelor's degree can act as a clinical expert and collaborate with investigators.

false

True or false....ANA sets standards for excellence and innovation in nursing education

false

True or false....ANA sponsored the Quality and Safety Education for Nurses (QSEN) initiative.

false

RN to BSN

graduates of a dimploma and ADN programs often elect to advance their education by earning a BSN.

This type of theory, Broad in scope, complex, require specification

grand

This type of nursing diagnosis is A clinical judgment of motivation, desire, and readiness to enhance well-being and actualize human health potential. Give some examples

health promotion nursing diagnosis EX:Readiness for enhanced coping Readiness for enhanced knowledge Readiness for enhanced nutrition

A registered nurse coordinates care delivery and uses strategies to promote health and a safe environment. Which American Nursing Association (ANA) standard of nursing practice is the registered nurse practicing?

implementation

This nursing process is the process of delivering care according to the care plan. the nurse will Reassess patient, educate clients for health awareness, analyze the assessment data for diagnosis, provide consultation to enhance client care. Review and revise the existing nursing care plan Organize resources and care delivers Anticipating and prevent complications

implementation

Certified nurse-midwives (CNM) are nurses trained to do what 3 things?

in providing care in pregnancy, conducting labor, and providing care to the newborn. The CNM does not have the authority to administer uterine relaxants. The CNM's role is much more than just providing antenatal care and she will not refer the client unless the labor is complicated.

General Systems Theory

includes purpose, content, and process, breaking down the "whole" and analyzing the parts. -all systems must be goal directed -a system is more than the sum of its parts -a system is ever changing, and any change in one part affects the whole -boundaries are implicit, and human systems are open and dynamic

Associate Degree Nursing

initially develop in the 1950s in response to a nursing shortage, and it continues to thrive today. -2 year community collegecredit for all courses and clinical experiences in nurshing

In the nursing process, these are selected to meet the patient's goal or outcome. They are selected after the goals and outcomes have been written.They are individualized to the patient's situation.

interventions

Competent

is reflected by the nurse who has been on the same job for 2 or 3 years and who consciusly nad deliberatly plans nursing care in terms of long range goals.

Define nursing (according to the American Nursing Association [ANA]).

is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations.

A nurse is found guild of performing procedures outside her scope of practice. Identify which element is true related to nursing scope of practice. a. scope of practice is defined by each state's nurse practice act b. the ANA sets requirements for licensure. c. scope of practice is defined by CNEA-accredited school curricula. d. Reciprocity explains the relationship between scope of practice.

my answer: a

A patient reports frustration that she has been unable to sleep while in the hospital and that she is exhausted. The nurse also notes that the patient has an unreliable social support network, has poor confidence in her ability to care for her self after discharge, and is a fall risk. Which one of these issues would take priority according to Maslow's hierarchy of human needs? a. sleep b. Fall risk c. social support d. doubt related to self-care

my answer: a

according to Patricia Benner's From Novice to Expert, there are five distinct levels of proficiency. Micha is a nurse with 3 years of experience who is now able to analyzy his patient's heart failure as conceptually reated to the renal failure and anemiathat are present rather than as seperate issues. Which level most appropriately describes his proficiency? a.competent b. expert c. novice d. advanced beginner

my answer: a correct answer: d. advanced beginner is identified as being the first 5 years after graduation from nursing school and is described as seeing situations in parts to seeing them more conceptually, or as a whole. Competency occurs 5 to 10 years after graduation, and the nurse is no longer outside the situation observing but is directly involved. The expert nurse has an enormous background of experience, intuitive grasp of each situation, and accurately targets the problem w/o unnecessary consideration of a large range of alternative diagnoses and solutions. The novice nurse moves from relying on abstract principles to using concrete experiences.

An antibiotic is ordered that the patient has had an allergic reaction to in the past. Which would be a appropriate nursing action as determined by the professional nursing role? Select all that apply. a. identify that the antibiotic is inappropriate b. document the allergy and call the physician c. administer the drug as ordered d. Complain to the other nurses about the physician's poor judgement

my answer: a & b

Marchy is aware that nursing responsibliites are realted to standers of profesionaly performance. Which are includied in these standards? select all that apply: a. Collaboration b. performances appraisal c. outcomes identification d. Quality of practice

my answer: a & d correct answer: a, b & d Collaboration, performance apraisal, and quaulity of care are all elements of professional performance. Other elements include education, collegiality, ethics, reserach and use of resources. Standards of care dsignate professional nursing reosponsibilityes such as assessment, diagnosies, outcome identifaciotn, planning, implemntation,s and evaluation...... need to finish this answer

This persons nursing theory was: Environment as the focus of nursing care Descriptive theory

nightingale

what are components of clinical judgment

noticing interpreting responding reflecting

This nurse role helps patients reach decisions that are best for them (at the same time, the nurse should not interfere with the decision-making of the patient).

nurse counselor

A nurse who has earned a Master's degree or a Doctor of Philosophy (PhD) in nursing degree or a Doctor of Nursing Practice (DNP) degree can become a _________________

nurse researcher

In the nursing process, the second step is to make clinical judgments. It includes critical analysis and interpretation of assessment data that reveal a patient's response to health problems with the goal of identifying patient needs and formulatin.

nursing diagnosis

The______________________ is a standard of practice, which, when followed correctly, protects nurses against legal problems related to nursing care.

nursing process

A statement such as: dry mucus membranes, poor skin turgor, fatigue, BUN 25mg/dL, creatinine 1.8mg/dL. Is this statement objective or Subjective?

objective

This persons nursing theory was: Focuses on patient's self-care needs Goal is for patient to manage his or her health problems.

orem

a measurable criterion to evaluate goal achievement...Must have a measurable amount...ex:: mr jacobs reports pain at a level 3 or below by discharge.

outcome

Acting as a ___________________, the nurse provides the necessary information for patients to make informed decisions related to choosing and using services appropriately.

patient advocate

_________________________refers to providing care with respect to clients' needs, values, and preferences.

patient centered care

Nursing Competencies, The Quality and Safety Education for Nurses (QSEN, 2014)

patient centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics

This persons nursing theory was: Focus on interpersonal relations between nurse, patient, and patient's family and Development of nurse-patient relationship

peplau

This nursing process, Requires the use of critical thinking skills, in which decision making and problem solving techniques are incorporated.It Involves setting priorities, identifying patient-centered goals and expected outcomes, and prescribing individualized nursing interventions.

planning

Consultatin occurs most often in which two stages of the nursing process?

planning and implementation.

second step in community assessment, obtain data about all the people that make up the area and demographics of the community. Who are the residents, what is the age range, and what types of ethnicity are represented?

population

This type of theory, Address nursing interventions for a phenomenon, and predict the consequence of a specific nursing intervention.

prescriptive

Between preventative and primary care, which one Reduces incidence of disease Minimizes complications Reduces the need for more expensive resources Occurs in home, work, and community settings

preventative care

1-________________care includes steps taken by health care providers to prevent a disease or disorder from occurring

primary

Between preventative and primary care, which one Focuses on improved health outcomes for an entire population Requires collaboration among health professionals, health care leaders, and community members

primary care,

a regulatory approach to reviewing the quality, quantity, and cost of hospital care provided through medicare

professional standard review organization

Who is the father of medicine?

Hippocrates

Who rejected the belief that diseases had supernatural causes?

Hippocrates

What types of settings are secondary and tertiary care found?

Hospitals and ICUs rural hospitals and psychiatric care

a critical care unit in the hospital

ICU

Research process is An orderly series of steps that allows a researcher to find the answer to a question what are the 5 steps?

Identify problem. Design study. Conduct study. Analyze data. Use the findings.

Autonomy

Independent nursing interventions that the nurse initiates without medical orders.

In-Service education

Instruction or training provided by health care agencies.

Mary Adelaide Nutting

Instrumental in moving nursing education into universities.

Evidence-Based Practice

Integrate the best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Examples: Demonstrate knowledge of basic scientific methods. Appreciate strengths and weaknesses of scientific bases for practice. Appreciate the importance of regularly reading relevant journals.

A set of providers and services organized to deliver a continuum of care in a cost effective setting

Integrated delivery Network

The ____________________________supports the need for nursing research as a means of improving the health and welfare of people.

International Council of Nurses (ICN)

What are the skills you need to have for critical thinking and clinical judgements?

Interpretation Analysis Inference Evaluation Explanation Self-Regulation

Nurse Researcher

Investigates problems to improve nursing care and to expand the scope of nursing practice.

Certified Nurse-Midwife (CNM)

Involves independent care for women in normal pregnancy, labor, and delivery and care of newborns.

Communicator

Is central to the nurse patient relationship.

Who established Nurses association Alumnae of US & Canada?

Isabel Hampton

This persons nursing theory was: Theory of cultural care diversity and universality Considers social structure factors

Leininger

Who opened the Henry street settlement in NY?

Lillian Wald

Inference

Look for the meanings of your findings

Nursing Administrator

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

Medical Judgement vs Nursing Judgement

Medical Judgement: more disease identification (lab values and see that it is hypertension) Nursing Judgement: -more doing for the pt when there unable to -identify symptoms or patient responses -allow for peaceful death and maintain pts dignity.

Safety

Minimize risk of harm to patients and providers through both system effectiveness and individual performance. Examples: Examine human factors and basic safety design principles and commonly used unsafe practices. Value own role in preventing errors.

Nurse Practioner

NP function with more independence and autonomy than do other nurses and are highly skilled at doing nursing assessments, performing physical examinations, counseling, teaching and treating health problems. -NP's have specialty, such as obstetrics, pediatrics, geriatrics, or family care. -Nps in some states have a broad scope of practice that includes ability to prescribe medications.

3rd Maslow's Hierarchy of Need:Love Needs

Need for affection, feelings of belongingness, and meaningful relations with others. -after a sense of safety is achieved, people need to feel that they belong and are loved to avoid loneliness and isolation. -to meet this need, a person must give and receive love.

1st Maslow's Hierarchy of Need: Physiologic Needs

Need for air, nutrition, water, elimination, rest and sleep, and thermoregulation. Sex is unnecessary for individual survival, but it is necessary for the survival of humankind. -Nurses assess each patient's ability to meet his or her physiologic needs and identify the nature and degree of nursing interventions necessary to enable the person to satisfy these needs.

2nd Maslow's Hierarchy of Need: Safety Needs

Need for shelter and freedom from harm and danger. -the need to be physically safe and free from the fear and anxiety that results from a lack of security and protection. Safety is often a dominant motivator

5th Maslow's Hierarchy of Need: Self-Actualization Needs

Need to be self-fulfilled, learn, create, understand, and experience one's potential. -to maximize one's potential. Maslow sees this as a never ending. -although early life experiences affect self-actualization, people have the capacity to change and to reach a state of optimal psychological health as they strive for it.

4th Maslow's Hierarchy of Need: Esteem Needs

Need to be well thought of by oneself as well as by others. -to be genuine, it must be firmly grounded in a realistic appraisal of one's strengths and weaknesses. -If esteem needs go unmet, the person faces a life characterized by self-doubt and feelings of helplessness and worthlessness

This persons nursing theory was: Based on stress and the patient's reaction to the stressor Role of nursing is to stabilize the patient or situation.

Neuman

What are Benner's 5 stages of nursing proficiency?

Novice Advanced beginner Competent Proficient Expert

This type of nurse investigates problems to improve nursing care and to further define and expand the scope of nursing practice.

Nurse researcher

This type of nurse works in an academic setting, hospital, or independent professional or community service agency.

Nurse researcher

Concept of a Person

refers to all human beings. People are the recipients of nursing care; they include individuals, families, communities and groups.

2-________________care includes measures taken after a disease or disorder has occurred to prevent complications.

secondary

A skilled care facility that provides intravenous therapy, wound care, long-term ventilator management and physical rehabilitation

skilled nursing facility

Third step in community assessment, Although the number of schools and churches were obtained when reviewing the community structure, it is important to know what, if any, community services are provided by the schools and churches, including parenting classes, support groups, and play days.

social systems

Compliance

state of being in accordance with established guidelines or specifications, or the process of becoming so ex: take your medication when asked to

Maslow's hierarchy of Human Needs

states that all humans are born with instinctive needs. Grouped into 5 categories, are arranged in order from those essential for physical survival to those necessary to develop a person's fullest potential. -A person is not motivated by all five categories at the same time. -the category most relevant to the person's circumstances at a particular time is the primary motivator. -human needs are motivational forces. -culture, socioeconomic factors, personal values, and health influence the motivational strength for and manner of expression of these needs. -all people develop behaviors that help them meet their needs. -they can learn to delay meeting their needs and modify the specific behaviors that satisfy needs, depending on each needs' motivational strength. -if a needs goes unmet, physical illness, psychological disequilibrium, or death can occur

Competent

A nurse who has been in the same clinical position for 2 to 3 years. This nurse understands the organization and specific care required by the type of patients. He or she is a competent practitioner who is able to anticipate nursing care and establish long-range goals. In this phase the nurse has usually had experience with all types of psychomotor skills required by this specific group of patients.

Advanced beginner

A nurse who has had some level of experience with the situation. This experience may only be observational in nature, but the nurse is able to identify meaningful aspects or principals of nursing care.

Basic level of critical thinking

(1st) New Nurses or student -Trust more with instructors than there own beliefs -Should be open minded and able to accept any diversities

Complex level of critical thinking

(2nd) -Separate themselves from expert -Examine the chooses more independently

Expert

A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem. This nurse is able to zero in on the problem and focus on multiple dimensions of the situation. He or she is skilled at identifying both patient-centered problems and problems related to the health care system or perhaps the needs of the novice nurse.

Proficient

A nurse with more than 2 to 3 years experience in the same clinical position. This nurse perceives a patient's clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. This nurse focuses on managing care as opposed to managing and performing skills.

Doctor of Nursing Practice

A practice-focused doctorate.

The examination of RN licensure provides:

A standardized minimum knowledge base for nurses.

What is a Profession

A systematic body of knowledge provides framework for proficient tracks Standardized formal higher education Commitment to provide service that benefits individual and community Autonomy, responsibility and accountability Standards and codes of ethics Commitment to members of profession through professional organization

Standards of Practice

ADOPIE -Assessment: collecting comprehensive data pertinent to the patient's heath or situation. -Diagnosis: analyzes the assessment data to determine the diagnoses or issues. -Outcome: identifies expected outcomes for a plan individualized to the patient or the situation. -Planning: develops a plan that prescribes strategies and alternatives. -Implementation: coordination of care, health teaching and health promotion, consultation, and prescriptive authority and treatment. -Evaluation: know the progress toward attainment of outcomes

This type of nursing diagnosis Describes human responses to health conditions or life processes... Give some examples

Actual nursing diagnosis EX:Social Isolation, Fluid, Volume Deficit, Pain

When the nurse protects the patient's human and legal right to make choices about his or her care.

Advocate

When the nurse provides additional information to help a patient decide whether or not to accept a treatment or find an interpreter to help family members communicate their concerns.

Advocate

what is clinical judgment

An interpretation or conclusion about a patient's needs, concerns or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient's response.

Graduate nurses must pass a licensure examination administered by the: 1. State Boards of Nursing 2. National League of Nursing 3. Accredited school of nursing 4. American Nurses Association

Answer: 1. State Boards of Nursing Rationale: Candidates are eligible to take the NCLEX-RN to become registered nurses in the state in which they practice.

A group that lobbies at the state and federal level for advancement of nurses' role, economic interests, and health care is the: 1. State Boards of Nursing 2. American Nurses Association 3. American Hospital Association 4. National Student Nurses Association

Answer: 2. America Nurses Association Rationale: The ANA's purpose is to improve the professional development and general welfare or nurses.

The factor that best advanced the practice of nursing in the twenty-first century was: 1. Growth of cities 2. Teaching of Christianity 3. Better education of nurses 4. Improved conditions for women

Answer: 3. Better education of nurses Rationale: Nursing is a combination of knowledge from the physical sciences, humanities, and social sciences along with clinical competencies.

The nursing process organizes your approach while delivering nursing care. To provide the best professional care to patients, nurses need to incorporate nursing process and: A. decision making B. problem solving C. Intellectual standards D. Critical Thinking Skills

Answer: D. Critical thinking skills •Rationale: The nursing process and critical thinking go hand-in-hand in providing patient-centered care. The nursing process cannot be completed without critical thinking in forming nursing diagnoses, setting goals, interventions, and evaluation.

Nursing standards provide the guidelines for implementing and evaluating nursing care. Six standards of practice ARE?

Assessment Diagnosis Outcomes identification Planning Implementation Evaluation

an attractive long term care arrangement providing a more homelike environmen and maximum resident autonomy

Assisted Living

adherence

Attachment or commitment to a person, cause, or belief. ex: take medication because you want to

Categories used as the basis for fixed reimbursement amounts with adjustments for the severity of cases, which give hospitals an incentive to reduce the legnth of stay of all clients

Diagnosis related groups (DRGs)

What are the specific critical thinking examples?

Diagnostic Reasoning Inference Clinical Decision Making

Who Established he Nurse Corps of the Unites State army?

Dorothea Dix

In identifying needs for health policy and health program development and services, a community assessment focuses on which of the following elements? A. Structure B. People C. Social systems D. Environments E. All of the above

E?

Revised standards of professional performance

ECCCLEEQPRE Ethics Culturally Congruent Practice Communication Collaboration Leadership Education Evidence Based Practice and Research Quality of Practice Professional Practice Evaluation Resource Utilization Environmental Health

Associate's degree

Emphasizes advanced knowledge in basic sciences and research based clinical courses.

Master's degree

Emphasizes research-based clinical practice

A problem-solving approach that integrates best current evidence with clinical practice is called?

Evidence-Based Practice

_____________________refers to incorporating better quality interventions based on research. Referring to articles and systematic reviews to determine optimal care for a client is an example

Evidence-Based Practice

Clinical Nurse Specialist (CNS)

Expert clinician in a specialized area of practice.

Educator

Explains, demonstrates, reinforces, and evaluates the patient's progress in learning.

what are 3 restorative care settings?

Extended Care, Rehabilitation home care

Environment

Factors that affect individuals internally and externally, everyday surroundings and where the nursing care is provided

Manager

Has personnel, policy, and budgetary responsibility for a specific nursing unit.

Examples of Clinical Decision Making

Have a holistic approach of the patients. Prioritize Care (triage)

What 6 changes in society lead to changes in nursing?

Health care reform Demographic changes Medically underserved Threat of bioterrorism Rising health care costs Nursing shortage

this initiative for achieving Healthy Populations and Communities' Goals are to increase life expectancy and quality of life, and to eliminate health disparities through improved delivery of health care services

Healthy People 2020

this initiative for achieving Healthy Populations and Communities Establishes ongoing health care goals

Healthy People Initiative (by USDHHS)

Caregiver

Helps the patient maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence.

This persons nursing theory was: 14 basic needs of the whole person Framing nursing care are the needs of the individual.

Henderson

Advance edcuation

-Continuing Education -RN to BSN -Master's Degree in Nursing -Doctor of Nursing Practice -Research Doctoral Degrees -Certifications

What external forces influence current nursing practices?

-Health care reform -Medically underserved people

what are the 6 categories of vulnerable populations?

-Immigrants -Poor and homeless -Abused -Substance abusers -Mentally ill -Older adults

Reflecting

-Last Component of Clinical Judgement model -Attending to patients' responses to the nursing action while in the process of acting -Deciding what was learned from the situation

Examples of Diagnostic Reasoning and Infernce

-Need to know reference ranges, the data that is collected, sign and symptoms, lab values -What is hyperkalemia? What is normal range for this? What is wrong with the patient? Is this relevant data?

Which nursing roles require a master's degree?

-Nurse educator -nurse administrator -Advance paractice registered nurse -Nurse researcher

Commitment level of critical thinking

-Take complete ownership of your decision -Can delay or pause for a treatment based on experience and knowledge -You'll understand what is going on and how to treat the patient

Gordon's model is an example of a structured database format. It has 11 functional health patterns that are assessed: What are they?

the health perception-health management pattern, nutritional-metabolic pattern, elimination pattern, activity-exercise pattern, sleep-rest pattern, cognitive-perceptual pattern, self-perception-self-concept pattern, role-relationship pattern, sexuality-reproductive pattern, coping-stress tolerance pattern, and the value-belief pattern.

What are the 7 things included in Community assessment: Structure

• Name of community or neighborhood • Geographical boundaries • Emergency services • Water and sanitation • Housing • Economic status (e.g., average household income, number of residents on public assistance) • Transportation

Documentation of Nursing has been around for how the last __________ years.

150

Explanation

Support your findings. Use your knowledge and experiences to choose strategies to use in the care of patients

Florence Nightingale defined nursing as:

The act of utilizing the environment of the patient to assist him in his recovery

Assessment

The registered nurse collects comprehensive data pertinent to the patient's health and/or the situation.

Helping the patients understand the consequences and complications of multiple medications helps to build the competency in

saftey

Reflection

Thinking about previous situations and considering relevant issues: What did I notice before? How did I act? What could I have done differently? What should I do next time in the same situation?

Improved delivery of health care occurs through what 3 things?

1. Assessment of health care needs of individuals, families, and communities 2. Development and implementation of public health policies 3. Improved access to care

Noticing

-1st component of clinical judgement model -Function of nurses' expectations of the situation. -Knowledge of a patient and their patterns of responses

Interpreting

-2nd component of clinical judgement model -Developing a sufficient understanding of the situation to respond.

Responding

-3rd component of clinical judgement model -Deciding on a course of action deemed appropriate for the situation. -Can include no immediate action

Practical Nursing

1 year programs that prepare them to perform techincal skills under the superision of registered nurses (RN). -Can take the NCLEX-PN to become a licensed practical nurse (LPN) -LPN differ from RN in 2 ways: 1. educational preparation 2. scope of practice Practical nursing was established to prepare healthcare providers for patient care and to assist professional nurses with routine technical procedures.

What are the 3 types of nursing diagnosis?

1)Actual Nursing Diagnoses (the problem is happening with the patient now) 2)Risk for Nursing Diagnoses (not currently happening, but patient is at risk for this unless there is intervention) 3)Health Promotion Nursing Diagnoses

considering the 3 types of nursing diagnosis, what are the difference between the 3 types?

1)medical:Identification of a disease condition based on specific evaluation of signs and symptoms 2)Clinical judgement about the patient in response to an actual or potential health problem 3)Actual or potential physiological complication that nurses monitor to detect a change in patient status

What are the 5 steps in the process of assessment?

1. Collect Data 2. Cluster cues, make inferences, and identify patterns and problem area. 3. Critically anticipate. 4. Be sure to have supporting cues before making an inference 5. Knowing how to frame questions (this is a skill that grows with experience).

What are the major routes leading to RN Licensure?

1. Diploma 2. associate degree, 3. baccalaureate degree there are new programs that have master's degree or doctorate as entry level preparation

Double vision or the two things community health nurses need are?

1-Care for the community as a whole 2-Assess the individual or family within the context of the community

During the assessment phase of the nursing process, there are two planned interventions...what are they?

1-Direct care-treatments performed through interactions with the patient Examples: giving medication, inserting an IV 2-Indirect care- treatments performed away from the patient, but on behalf of the patient. Examples: Infection Control, documentation, collaborating with others

What are the responsibilities of a nurse educator?

1-Explain concepts and facts about health to clients 2-Teach the client to self-administer insulin injection

What are 4 things Florence nightengale is known for?

1-First practicing epidemiologist 2-Organized first school of nursing 3-Improved sanitation in battlefield hospitals 4-Her practices remain a basic part of nursing today.

what are 3 focuses of Community-Based Nursing

1-Health Promotion 2-Disease Prevention 3-Restorative Care

3 types of nursing interventions:

1-Nurse Initiated Independent actions the nurse initiates They do not require an order, supervision, or directions from others Often pertain to activities of daily living, health education and promotion and counseling. 2-Physician initiated Dependent actions Require an order from a physician or other health care professional 3-Collaborative Interdependent Require combined knowledge, skill, and expertise of multiple health care professionals

What achievements is Mary Mahoney known for?

1-She focused on respecting an individual irrespective of color, race, or background. 2-She was the first professionally trained African-American nurse

What are the stages of a client-centered interview in the appropriate order.

1. Setting the stage 2. Setting an agenda 3. Collecting nursing history 4. Terminating the interview

Whate are the Six steps provide a systematic approach to rational clinical decision making:

1. Ask the clinical question. 2. Collect the best evidence. 3. Critique the evidence. 4. Integrate the evidence. 5. Evaluate the practice decision or change. 6. Share the outcomes of EBP changes with others.

11 components of Nursing

1. Holism 2. caring 3. teaching 4. advocacy 5. supporting 6. promoting 7. maintaining 8. restoring health 9. creativity 10. sensitivity 11. applications based on evidence

Nurse Licensure Compact

1. Idaho 2. Mississippi 3. Utah 4. Kentucky 5. Arizona 6. Tennessee 7. Colorado 8. South Carolina 9. New Mexico 10. North Carolina 11. Texas 12. Virginia 13. North Dakota 14. Maryland 15. South Dakota 16. Delaware 17. Nebraska 18. Rhode Island 19. Iowa 20. New Hampshire 21. Missouri 22. Maine 23. Arkansas 24. Montana 25. Wisconsin

Institute of Medicine Recommendations Box 1-1 pg. 7

1. Nurses should practice to the full extent of their eduction and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the U.S. 4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

What is critical thinking?

Recognizing that an issue exists, analyzing information, evaluating information, and drawing conclusions

How many levels does a nurses pass through when acquiring and developing nursing skills?

5

What percentage of Nurses work in Hospitals?

60%

What percentage does the task force recommend nurses to have a higher level of education with a baccalaureate level or higher?

80%

Baccalaureate degree

A 4 -year program that includes social sciences, arts, and humanities.

Novice

A beginning nursing student or any nurse entering a situation in which he or she has no previous experience. Behavior is governed by established rules and is limited and inflexible.

self-regulation

Reflect on your experiences. Identify the ways you can improve your own performance. What will make you believe that you have been successful?

The use of diagnostic reasoning involves a rigorous approach to clinical practice and demonstrates that critical thinking cannot be done: A. logically B.Haphazardly C.Independently D. Systematically

B: Haphazardly Rationale:Critical thinking should be done using a systematic approach, using knowledge and experience to formulate an opinion.

Baccalaureate Degree Nursing

BSN, offers students a full college/university education with a background in liberal arts.

Levels of Critical Thinking in nursing

Basic, Complex, Commitment

Analysis

Be open-minded as your looking for info about patient. Look to see if the data reveals a problem or trend. Look to see if there are others options.

Novice

Beginning nursing student or any nurse entering a situation in which there is no previous experience. The learner learns via a specific set of rules and procedures, which are usually stepwise and linear.

How did Florence Nightingale see the role of the nurse in the early 1800s?

Being in charge of a patient's health based on the knowledge of how to put the body in such a state as to be free of disease or to recover from disease.

Interpretation

Being orderly in collection patient date. Apply reasoning while looking for patterns.

This persons nursing theory was: Caring is central.

Benner and Wrube

In Western civilization, Nursing grew with the continuing spread of _________________. which had positive effects on cultural values and institutions.

Christianity

Who is the Nurse that practiced nursing on Civil War battlefields?

Clara Barton

Who founded the Red cross?

Clara barton

Factors Affecting Clinical Judgment

Context of the situation Culture of the nursing unit Experience Intuition and perception

Difference between Critical Thinking and Critical Judgement

Critical Thinking: Application of knowledge and experience to identify pt problems and direct clinical judgments in positive patient outcomes. Clinical Judgment: more influenced by what nurses bring to the situation, is based on knowing the patient, is influenced by the culture of the nursing environment (unit), is based on a variety of reasoning processes, and is refined by reflection on actions taken in various situations.

Whats the difference between Cues and Inference?

Cues-information you collect using your senses Inferences-your judgement or interpretation of the cues you gathered

Nurse Practice Act

Defines the practice of nursing, varies in each state. -New grads must take the NCLEX to qualify for a nursing licensure. -as long as the nurse maintains licensure, the licensure exam does not need to be retaken. -The Nurse Licensure Compact allows nurses licensed in a compact state to practice in other compact states w/o obtaining licensure in the new state. -24 states are members of the compact.

Nurse Practitioner

Detects and manages self-limiting acute and chronic stable medical conditions.

How can you develop critical thinking skills?

Reflective journaling Meeting with collegues Concept mapping

Mary Mahoney

First professionally trained African-American nurse.

Who is the Founder of Modern Medicine?

Florence Nightingale

Who founded St. Thomas Hospital in London

Florence nightengale

Continuing education

Formal, organized educational programs offered by various institutions.

Clara Barton

Founder of the American Red Cross

Advanced Practice Registered Nurse (APRN)

Four core roles. There are four core roles : Certified Nurse Specialist (CNS) Certified Nurse Practitioner (CNP) Certified Nurse Midwife (CNM) Certified RN Anesthetist (CRNA)

Teamwork and Collaboration

Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care. Examples: Recognize the contributions of other heath team members and patient's family members. Discuss effective strategies for communicating and resolving conflict. Participate in designing methods to support effective teamwork.

What are the critical thinking competencies?

General and Specific Critical thinking

_____________________describes the study of all the genes in a person and the interactions of these genes with one another and with that person's environment.

Genomics

broad statement that describes a desired change in a condition or behavior (short or long term) is called?

Goal

Change Theory Kurt Lewin (1962)

People grow and change throughout their lives. This growth and change are evident in dynamic nature of basic human needs and how they are met. six components are: 1. Recognition of the area where change is needed. 2. analysis of a situation to determine what forces exist to maintain the situation and what forces are working to change it. 3. Identification of methods by which change can occur 4. recognitiion of the influence of group mores or customs on change. 5. identification of the methods that the reference group uses to bring about change. 6. the actual process of change. Unfreezing Movement Refrezzing

Describe nursing's code of ethics.

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

Ernest Grant

President of ANA

What are the 3 components of a nursing diagnosis?

Problem, Etiology, Symptoms

What are differences between the 3 components of a nursing diagnosis?

Problem:-NANDA approved diagnosis (also called diagnostic label) Etiology:-What the problem is related to. This CANNOT be a Medical Diagnosis Symptoms:-Defining characteristics (the subjective and objective data) Written out "as evidenced by"

Advocate

Protects patients' human and legal rights and provides assistance in asserting these rights.

Nurse Midwife

Provide independent care for women during normal pregnancy, labor, and delivery. -They practice in conjunction with specific healthcare agencies from which medical services are available in the event a patient develops complications. -may perform Pap smears, breast examinations and assist in family planning

What did the RWJF and IOM do

Provided good things to the public about nursing

Nurse Anesthestist

Provides general anesthesia for patients undergoing surgery. Nurse anesthetist are RNS with advanced education in anesthesiology. They work in hospitals and out patient surgery settings

Certified Registered Nurse Anesthetist (CRNA)

Provides surgical anesthesia.

Jean Watson (1979) Nursing: The Philosophy and Science of Caring

Purpose: To focus on curative factors derived from a humanistic perspective and from scientific knowledge.

Martha E. Rogers (1970) Theoretical Basis of Nursing

Purpose: to assist the patient in achieving a maximum level of wellness

Virginia Henderson (1955) The Nature of Nursing

Purpose: to assist the patient in gaining independence as rapidly as possible.

Hildegard E. Peplau (1952) Interpersonal Relations in Nursing

Purpose: to develop an interpersonal interaction between patient and nurse.

Florence Nightingale,(1860) Notes on Nursing; What it is, and what it is Not

Purpose: to help individuals responsible for caring for the sick to "think how to nurse." Theory addresses fundamental needs of the sick and basic principles of good healthcare.

Sister Callista Roy (1970)

Purpose: to identify the types of demands placed on a patient and the patient's adaptation to the demands.

This type of care includes Provision of medically related professional and paraprofessional services and equipment to patients and families in their homes for health maintenance, education, illness prevention, diagnosis and treatment of disease, palliation, and rehabilitation Involves coordination of services Focuses on patient and family independence Usually reimbursed by government (such as Medicare and Medicaid in the United States), private insurance, and private pay sources

Restorative Care: Home Care

In acient Babylonia, Eygpt and Samaria,_______________ _________________ were primary recipients of nursing care.

Rich families

Doctor of Philosophy

Rigorous research and theory development.

What are the two health care advocacy groups

Robert Wood Johnson Foundation (RWJF) and Institute of Medicine (IOM)

_____________________ refers to performing interventions that minimize

Safety

What are the general critical thinking?

Scientific method Problem Solving Decision Making

This type of care as explained in the health services pyramid, Also called acute care Focuses on Diagnosis and treatment of disease Disease management is the most common and expensive service of the health care delivery system. 20% require 80% of health care spending. Fastest growing age group of uninsured? Postponement of care by uninsured

Secondary and Tertiary Care

What is a process that involves learning theory and skills and internalizing an identity appropriate to a specific role?

Socialization

Continuing Education

Some states require nurses to obtain continuing education hours for ongoing licensure. Courses range from an hour to days to weeks in length and may be offered by the nurses's employer, local colleges, or by independent companies

What are Critical Thinking Components for Clinical Decision Making?

Specific Knowledge Base Experience Nursing Process Competency (CT competencies) Attitudes for critical thinking Professional standards

first step in community assessment, geographical boundaries of the community are identified. Look at for example: schools, churches, types of residences.

Structure

A statement such as: patient states, "I've haven't kept any food down in three days." "I've had diarrhea for two days." Is this statement objective or Subjective?

Subjective

What is the purpose of Nurse Practice Acts?

The purpose is to regulate the scope of nursing practice and protect public health, safety, and welfare.

Diagnosis

The registered nurse analyzes the assessment data to determine the diagnosis or issues.

Education

The registered nurse attains knowledge and competency that reflects current nursing practice.

Collaboration

The registered nurse collaborates with health care consumer, family, and others in the conduct of nursing practice.

Communication

The registered nurse communicates effectively in all areas of practice.

Quality of Practice

The registered nurse contributes to quality nursing practice.

Leadership

The registered nurse demonstrates leadership in the professional practice setting and the profession.

Professional Practice Evaluation

The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.

Evaluation

The registered nurse evaluates progress toward attainment of outcomes.

Outcomes Identification

The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation.

Evidence-Based Practice and Research

The registered nurse integrates evidence and research findings into practice.

Ethics

The registered nurse practices ethically

Environmental Health

The registered nurse practices in an environmentally safe and healthy manner.

Resources

The registered nurse uses appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible.

Betty Neuman (1972), The Neuman Systems Model: Application to Nursing Education and Practice

To address the effects of stress and reactions to it on the development and maintenance of health

The goals of any professional nursing organization is to:

To improve the standards of practice, expand nursing roles, and foster the welfare of nurses within the specialty areas.

Dorothea E. Orem (1971) Nursing: Concepts of Practice

To provide care and to assist the patient to attain self-care.

True or False....A doctoral education is required to design research studies independently and acquire funding for research.

True

True or False....A nurse with a Bachelor's degree is not responsible for providing leadership for integrating findings in practice.

True

Evaluation

Use criteria (expected outcomes, objectives) to determine results of nursing actions

Nurse Educator

Works primarily in schools of nursing and staff development.

Nursing responsibliities

advances in technology, knowledge , health promotion and prevention have expanded the functions of nurses today. -turing or reposition bed patients every 2 hours. -although physicians delegate actions (physician-prescribed interventions) that require nurses to use their own judgment, nurses are addressing collaborative problems. -for example, although physicians must prescribe Medications, thye rely on the judgement of nurses to use their own judgment Caregiver Patient Advocate Educator Decision Maker Manager and Coordinator Communicator

Define the term genomics.

describes the study of all the genes in a person, as well as interactions of those genes with each other and with that person's environment.

This type of theory, Describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena.

descriptive

Graduate entry programs

designed for people for people with baccalaureate degrees in fields of study other than nursing. - an accelerated pace program

______________Is the perspective of a profession Provides the subject, central concepts, values and beliefs, phenomena of interest, and central problems of a discipline

domain

American Nurses Association (ANA)

it sets the standards of practices for nurses (ANA, 2015) and makes decisions about the functions, activities, and goals of the nursing profession. -a voice for nurses because it acts on issues and wishes expressed by its membership. -as stated in current bylaws, goals are to improve health standards and the availability for all, foster high standards of nursing, and to stimulate and promote the professional development of nurses and advance their economic and general welfare

Nurse administrator

manages and controls patient care. JCHO inspections. Need a Master's degree

A federally funded, state-operated program of medical assistance to people with low income.

medicaid

What are the 3 types of nursing diagnosis?

medical, nursing (or diagnostic label), collaborative

A federally funded, national health insurance program in the United States for people over the age of 65.

medicare

This type of theory, More limited in scope and less abstract

middle-range

Early Hospitals were often founded by _____________ ________________.

religious groups

Nurse researcher

responsible for the continued development and refinement of nursing knowledge and practice through the investigation of nursing problems. usually at the doctoral level. -work in teaching hospitals and research centers or in academic settings.

This type of nursing diagnosis Describes human responses to health conditions or life processes that may develop. Give some examples

risk for Nursing diagnosis EX:Risk for falls Risk for acute confusion Risk for constipation Risk for suicide

This persons nursing theory was: Views the patient as an adaptive system When patient cannot adapt to stressors, nursing is needed.

roy

Helping the clients understand the consequences and complications of multiple medications helps to build the competency in ______________

safety

_____________________________ refers to work with a health care team to achieve the best quality of client care.

teamwork and collaboration

disorder has occurred to prevent complications. 3-________________care includes measures taken to manage the complications.

tertiary

The value of certification is:

that the nurse may chose to be certified in a specific area of practice by meeting the practice requirements.

Diploma Nursing

the first type of educational preparation available for RNs. -Requires 3 years of study -student earns some college credit but college credit is not awarded for nursing courses -their numbers have declined as nursing education moves into institutions of higher learning

Marjory Gordon's (2002) Concept of Functional Health Patterns

these patterns delineate human needs of the person, family, community, and group. The patterns, which focus on behaviors that occur with time, present a total picture of the patient rather than just a small part of his or her life. -functional health patterns represent basic health needs that develop as people strive to meet those needs. -These patterns are unique because they are interrelated: one pattern often provides answers to another.

True or False....A nurse with an associate's degree can only participate in nursing research at a low level.

true

True or False....Asking the client about the hygiene and the sanitation in his community is part of the nursing assessment?

true

True or false.....ANA is a part of the International Council of Nurses (ICN)

true

True or false....ANA employs registered nurses as lobbyists at the federal level

true

True or false....ANA lobbied state legislatures to restrict the length of overtime for individual nurses

true

What are the 7 things included in Community assessment: Population

• Age distribution • Sex distribution • Growth trends • Density • Education level • Predominant ethnic groups • Predominant religious groups

What are the 6 things included in Community assessment: Social System

• Education system • Government • Communication system • Welfare system • Volunteer programs • Health system