Chapters 1-10
Professional Values
1. Altruism 2. Autonomy 3. Human Dignity 4. Integrity 5. Social Justice
QSEN (Core Competencies for Healthcare Professionals)
1. Provide Patient Centered Care 2. Teamwork/Collaboration 3. Employ Evidence Based Practice 4. Informatics 5. Quality Improvement 6. Safety
Four Aims of Nursing
1. promote health 2. prevent illness 3. restore health 4. facilitate coping w/ death or disability
Four Concepts common in nursing theory that influence and determine nursing practice are
1. the patient 2. the environment 3. health 4. nursing
Maslow's Hierarchy
5 levels of human needs; Arranged to show that certain needs are more basic than others (physiologic being the most basic... but most essential!) 1. Physiologic needs (oxygen) 2. safety and security 3. love and belonging 4. self- esteem 5. self-actualization Nursing care is directed at meeting unmet or threatened needs.
SBAR
A method of communication between 2 or more members of the health care team which includes 4 steps: 1. Situation 2. Background 3. Assessment 4. Recommendation This process is utilized to enhance communication among staff members to avoid medical errors and patient safety risks.
Continuity of Care
Coordination of services provided to patients before they enter a healthcare setting, during the time they are in the setting, and after they have the setting
Nursing Theories: Purpose and Description
Direct nurses to a common goal -Provide rational knowledgeable reasons for nursing interventions -Give nurses the knowledge base necessary for acting and responding appropriately in nursing care situations -Provide a base for discussion -Ideally help resolve current nursing issues -Give better problem-solving skills -Enhance nursing interventions to be more organized, considered and purposeful -Prepare the nurses to question assumptions and values in nursing -Identify and define interrelated concepts important in nursing -Nursing theories should be simple and general -Should also increase the nursing profession's body of knowledge by generating research to guide and improve practice -Can be descriptive: describe a phenomenon, an event, a situation, or a relationship -Can be prescriptive: address nursing interventions and the consequences of those interventions; designed to control, promote, and change clinical nursing practice. -guides nursing practice by: providing a knowledge base organizing concepts providing guidelines for practice identifying nursing care goals
Ethical Principles: Beneficence
Emphasizes the importance of preventing harm and ensuring the patient's well-being. Harm can be avoided if the causes or possible causes are identified.
Quality Improvement
Ensuring patient and staff safety through the use of 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 health care systems. As a med-surg nurse, it is expected to identify indicators to monitor quality and effectiveness of health care, access and evaluate data to monitor the quality and effectiveness of health care, recommend ways to improve care processes, and implement activities to improve care processes.
Collaboration
Entails planning, implementing, coordinating and evaluating patient care together using an interdisciplinary plan of care
Roles of the Nurse/ Goal of Home Healthcare
Goal: Helping the patient reach maximum independence and health Roles of nurse in reaching this goal: -focusing on community-based care taking into account the environmental, socioeconomic, cultural, and personal factors that affect the patient's and family's health -providing direct care -supervise other care providers -coordinate care with members of the healthcare team -advocate for the patient and family -educate family or other caregivers
Cultural assimilation
Process that occurs when a minority group, living as part of a dominant group within a culture, loses the cultural characteristics that made it different
Ethical Principles: Social Justice
Refers to equality; all patients should be treated equally and fairly . For example, a patient who cannot afford health care should receive the same quality and level of care as one who has extensive insurance coverage.
Medicare
Social security act of 1965 to provide a measure of health coverage to all Social Security recipients of the aging population (age 65+); payment plans dependent on diagnostic-related groups (DRGs)
Discharge Planning
Systematic process of preparing the patient to leave the healthcare facility and for maintaining continuity of care.
Cultural blindness
The process of ignoring differences in people and proceeding as though the differences do not exist
Ethical Principles: Self-Determination/ Self-Management
Treating patients as autonomous individuals capable of making informed decisions about their care. When a patient is not capable of this, the nurse is ethically obligated to protect the patient as an advocate within their scope of practice, according to the ANA Code of Ethics for Nurses
Patient Education
U.S. courts affirm the patient's right to know and view patient education as a legal duty of the nurse. Standards for patient education are derived from national professional standards and from the Nurse Practice Acts as well as the local standards described in the policies, procedure manual, and job descriptions. Failure to conduct or documented the assessment of learning needs and teaching may later be construed negligence. Remember that an important aim in a nursing is to assist patients in managing their own care. Discuss the nursing plan of care with patients and family members, and identify their learning needs and learning readiness. Document the teaching plan as part of the nursing plan of care. Document all nursing effort to educate the patient and family about healthcare management, and also document the patient's response. If a patient refuses health education or refers you to a family member, document this in the patient's record.
Altruism
a concern for the welfare and well-being of others, in professional practice, reflected by the nurse's concern for the welfare of patients, other nurses, and other healthcare providers
Checklist to ensure informed consent
a. Disclosure: pt/surrogate has been informed of the 1. nature of the procedure 2. risks and benefits 3. alternatives 4. fact that no outcomes can be guaranteed b. Comprehension patient/surrogate can correctly repeat in his or her own words that for which they are giving consent c. Consent pt understands the information needed to make this decision, is able to reason in accord with a relatively consistent set of values, and can communicate a preference surrogate meets above criteria, knows the patient's wishes to the extent that this is possible, and is free from undo stress and conflict of interests d. Voluntariness the pt is voluntarily consenting or refusing. care has been taken to avoid manipulative or coercive influences.
illness
abnormal process in which any aspect of the person's functioning is altered (in comparison to the previous condition of health).
Integrity
acting in accordance with an appropriate code of ethics and accepted standards of practice; reflected in professional practice when the nurse is honest and provides care based on ethical framework that is accepted within the profession
Nonmaleficance
avoid causing harm
Ethnocentrism
belief that one's own ideas, beliefs, and practices are best, superior, or most preferred to those of others
Cultural diversity
diverse groups in society, with varying racial classification and national origin, religious affiliation, languages, physical size, gender, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location
Race
division of human beings based on distinct physical characteristics
Standing Orders
empower the nurse to initiate actions that ordinarily require the order or supervision of a physician; document that details the nursing care to be implemented in specific nursing situations, frequently when a physician is not present; may expand scope of nursing responsibilities Examples: admission protocols for for OB patients, bowel programs that allow the nurse to select and administer necessary bowel interventions, standard orders for narcotic overdoses that specify the agents the nurse is to administer to reverse respiratory depression in an emergency, and standard orders for pain management that enable the nurse to select the strength of the medication to be given within preset ranges
Medicaid
established in 1965 under Title 19 of the SSA. Federally funded public assistance program for people of any age who have low incomes; for the blind, elderly, and disabled covered by supplemental security benefits; for beneficiaries of Aid to Families with Dependent Children. Coverage depends on individual state regulations.
Informed consent or refusal
every person is granted freedom from bodily contact by another person unless consent is granted. In all healthcare agencies, informed and voluntary consent is needed for admissions. Must be written, designated for the procedure to be performed, and signed by the patient or person legally responsible for the patient. A signed consent is not needed in an emergency if there is an immediate threat to life or health. Role of the nurse is to confirm that a signed consent form is present in the patient's chart and to answer any patient question about the consent. You may be responsible for having the patient sign the consent after the physician has explained the procedure, its risks and benefits, alternatives, etc.
Subculture
group of people with different interests or goals than the primary culture
Safety and security needs
involve both physical and emotional components; Physical safety and security involves being protected from both potential or actual harm. Emotional safety and security involves trusting other and being free of fear, anxiety, and apprehension
Informatics
involves using information and technology to communicate, manage knowledge, mitigate error, and support decision-making.
chronic illness
irreversible illness that causes permanent physical impairment and requires long term healthcare.
fidelity
keeping promises
Contracts
may be defined as the exchange of promises between 2 parties. the agreement may be in writing or oral, although oral contracts may be more difficult to prove. the law of contract provides a remedy for a breach of contract so that the person who suffers from a broken contract may be compensated for any resulting loss. for a contract to be legally enforceable, it must involve a real consent of the parties, a valid consideration, a lawful purpose, competent parties, and the format required by law practicing nurses enter into legally valid and binding contract with both their employers and their patients
Physiologic needs
oxygen, water, food, temperature, elimination, sexuality, physical activity, and rest must be met at least minimally to maintain life. Most basic and most essential to life.
acute illness
rapidly occurring illness that runs its course, allowing the person to return to his or her previous level of functioning.
Human Dignity
respect for the inherent worth and uniqueness of individuals and populations; reflected in nursing care when the nurse values and respects all patients and colleagues
Ethnicity
sense of identification that a cultural group collectively has; the sharing of common and unique cultural and social beliefs and behavior patterns, including language and dialect, religious practices literature, folklore, music, political interests, food preferences, and employment patterns
Culture conflict
situation that occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values
health
state of optimal functioning or well-being.
Culture
sum total of human behavior or social characteristics peculiar to a specific group and passed from generation to generation or from one to another within the group
Cultural imposition
tendency of some to impose their beliefs, practices, and values on another culture because they believe that their ideas are superior to those of another person or group
Evidence Based Practice (EBP)
the integration of the best current evidence to make decisions about patient care. It considers patient preferences and values, as well as one's own clinical expertise for the delivery of optimal health care. (The best source of evidence is research. Howver, Nursing research is limited.)
Collecting Bargaining
the legal process in which representatives of organizing employees negotiate with employers about matters such as wages, hours, and conditions. The 2002 revision of the American Nurse's Association Code of Ethics for Nurses states "participates in establishing, maintaining and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. Arbitration, strikes, and threats of strikes may be used to enhance terms of employment and to enforce contracts
Self-Esteem needs
the need for a person to feel good about himself or herself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments. Many factors affect self-esteem including role changes and a change in body image. It is important to remember that the person's perception of change has the greatest effect on self-esteem rather than the actual change itself.
Self Actualization needs
the need for individuals to reach their full potential through development of their unique capabilities. Each lower level of need must be met to some degree before this level can be met, which includes: -acceptance of self and others as they are -focus of interest on problems outside outside oneself -ability to be objective -feelings of happiness and affection for others -respect for all people -ability to discriminate between good and evil -creativity as a guideline for solving problems and pursuing interests How to help pt meet this need: Nurse should focus on: -person's strengths and possibilities rather than on problems. Nursing interventions are aimed at providing a sense of direction and hope and providing teaching aimed at maximum potentials
ANA Standards of Nursing Practice: Diagnosis
the nurse analyzes the assessment data to determine the diagnoses or issues
Standards of Professional Performance: Education
the nurse attains knowledge and competency that reflects current nursing practice
Standards of Professional Performance: Collaboration
the nurse collaborates with patient, family, and others in conduct of nursing practice
ANA Standards of Nursing Practice: Assessment
the nurse collects comprehensive data pertinent to the patient's health or situation
Standards of Professional Performance: Resource Utilization
the nurse considers factors related to safety, effectiveness, cost and impact on practice in the planning and delivery of nursing services
ANA Standards of Nursing Practice: Planning
the nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes
Standards of Professional Performance: Practice Evaluation
the nurse evaluates one's own practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations
ANA Standards of Nursing Practice: Evaluation
the nurse evaluates progress toward attainment of outcomes
ANA Standards of Nursing Practice: Outcomes Identification
the nurse identifies expected outcomes for a plan individualized to the patient or the situation
ANA Standards of Nursing Practice: Implementation
the nurse implements the identified plan, coordinates care delivery, employs strategies to promote health and a safe environment
Standards of Professional Performance: Ethics
the nurse integrates ethical provisions in all areas of practice
Standards of Professional Performance: Research
the nurse integrates research findings into practice
Standards of Professional Performance: Collegiality
the nurse interacts with and contributes to the professional development of peers and colleagues
Family-centered care
the nurse is an advocate for the patient, as well as the family. The nurse empowers the patient and family by teaching them to have more control over their care.
Standards of Professional Performance: Leadership
the nurse provides leadership in the profession and the professional practice setting
Standards of Professional Performance: Quality of Practice
the nurse systematically enhances the quality and effectiveness of nursing practice
Competent Practice
the nurse's most important and best legal safeguard. Each nurse is responsible for making sure that his or her educational background and clinical experience are adequate to fulfill the nursing responsibilities described in the job description Legal safeguards include: -Respecting legal boundaries -Following institutional procedures and policies -"owning" personal strengths and weaknesses; seeking means of growth, education, and supervised experience to ensure continued competence for new and evolving responsibilities -evaluating proposed assignments; refusing to accept responsibilities for which you are unprepared -keeping current -respecting patient rights and developing rapport with patients -keeping careful documentation -working within the agency to develop and support management policies
Acculturalization
the process of becoming accustomed to the customs, language, practices, and environment of a new culture over time
Autonomy
the right to self determination; nurse reflects this when he/she respects patients' rights to make decisions about their healthcare
Love and Belonging Needs
the understanding and acceptance of others in both giving and receiving love , and the feeling of belonging to families, peers, friends, a neighborhood, and a community
Culture shock
those feelings, usually negative, a person experiences when placed in a different culture
Social Justice
upholding moral, legal and humanistic principles. Reflected in professional practice when the nurse works to assure equal treatment under the law and equal access to quality healthcare
Patient-centered care
where the medical-surgical nurse recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs
