Introduction to Nursing Exam 3: Study Guide
Ethnocentrism
Nurses respond to sick people based not only on their formal education, but also on their own socialization and culture. All persons can be unaware of their own biases and tend to be ethnocentric (inclination to view one's own cultural group as the standard by which to judge the value of other cultural groups)
Relationship between nursing theory, research, and practice (review previous notecard)
Nursing practice is improved by evidence-based practice (Pg. 189)
Nursing Theorists: Jean Watson
OUT: open, understanding, trust How can I create an environment of trust, understanding, and openness so that the patient and I can work together in meeting his/her needs? Theory of caring Trust and understanding
Legal Aspects of Nursing
Objectives: Defines the practice of professional nursing. Sets minimum educational qualifications. Determines the legal titles and abbreviations nurses use. Provides disciplinary action. Statutory law.
3 major concepts of nursing: Health (pg. 160)
On a continuum Dynamic Holistic Affected by health beliefs and behaviors
3 major concepts of nursing
Person, health/illness, and environment
Other test-taking strategies (pg. 208-217)
Prioritize- Fill in the blank- Choose multiple responses- Use a figure or illustration- Determine what the question is asking Keep track of time during tests. Don't change your answer!!! Don't choose a totally unfamiliar answer if you aren' sure.
Delegation
Professional nurses may delegate independent nursing activities to other nursing personnel, but LVNs and LPNs can NOT delegate. Also, professional RNs retain accountability for acts delegated to another person
The principle of double-effect
Proposed action independent of its consequences must be good or at least morally neutral Only good effects are intended
Authority of state boards of nursing to award licenses to practice nursing and discipline nurses
The purpose of licensing certain professions is to protect the public health, safety, and welfare of the people. The state boards of nursing has the power to sanction a nurse for performing professional functions that are dangerous to patient (probation, suspension, revocation)
Theories of nursing
Theory guides the professional nurse in: Making sound clinical judgements based on evidence by determining which data are important, organizing, analyzing, and understanding connections in patient data. Planning appropriate nursing interventions Evaluation outcomes of interventions Theories usually propose specific outcomes
Application triad
Theory, practice, research (shape policies and procedures) *provides a framework and guidance Knowledge connections
How does nursing theoretical works guide the practice of nursing?
Theory-based practice; occurs when nurses intentionally structure their practice around a particular nursing theory and use it to guide them as they use the nursing process to assess, plan, diagnose, intervene, and evaluate nursing care. Theory provides a systematic way of thinking about nursing that is consistent and guides the decision-making process as data are collected, analyzed, and used in the planning and administration of nursing practice
Nursing behaviors and attitudes demonstrated by a culturally competent nurse (4)
They take cultural differences into consideration, are aware of potential "trouble spots" that can occur, usually interpret patient behavior accurately, and recognize problems that need to be managed. Cultural norms must be included in the plan of care to prevent conflicts between nursing goals and patient/family goals
Nursing Theorists: Imogene King
Triple G Goals, goals, goals What goals can we set together to restore a patient to health? Goal attainment theory Goals
3 major concepts of nursing: Person (pg. 153)
Unique, adaptable Open system w/subsystems Influenced by genetics and environment Motivated by needs Seeks homeostasis (fluid balance)
Theories of Ethics: Utilitarianism
Moral rightness of an action is determined solely by its consequence (triage; prioritize)
Nursing Theorists: Sister Callista Roy
Adaptation (The Cross) How can I modify this patient's environment to facilitate his/her adaptation? Adaptation Model Theory Adaptation
3 major concepts of nursing: Environment (pg. 155)
Affects well-being Physical (air, water, etc.) Nonphysical (family, culture, social structures)
Dilemmas involving peers' and other professionals' behavior
All practicing nurses participate as members of the health care team. This involves cooperation and collaboration with other professionals. Conflicts may arise between two nurses, a physician, agency policies, or other health care professional. Unethical actions results when health care workers break basic norms of conduct toward others, especially the patient, whatever the reason. Nurses and substance abuse during work
Theories of Ethics: Deontology
An act was moral if its motives or intentions were good, regardless of outcome
Ethical Principles (Principlism): Autonomy
An individual's right to determine their own actions; freedom to make their own decisions Asking for permission before touching pt., informed consent
HIPAA (pg. 115)
The Health Insurance Portability and Accountability Act (1996) Protection of patient's medical records and patient confidentiality A nurse can lose her license for violating HIPAA
Commission
Doing something that should not have been done
Dilemmas resulting from personal value systems
Each person has a set of values that was shaped by the beliefs, purposes, attitudes, qualities, and objects of a child's early caregivers. Variations in value systems become significant when dealing with critical issues such as health and illness or life/death Code of Ethics Personal values in conflict with professional values
Ethical Principles (Principlism): Justice
Equals should be treated the same; impartiality to provide equality of service
UTA Code of Ethics for nursing students
Ethical decision making Client privacy, confidentiality, and safety, while accepting individual accountability. Honesty and integrity Beneficence Non-maleficence Justice Autonomy Veracity Fidelity
Omision
Failing to do things that should have been done
Nursing Theorists: Florence Nightingale
First nursing theorist What needs to be adjusted in this environment to protect the patient? Sanitation, sleep, and nutrition
What is cultural competence?
Guides the nurse in understanding behaviors and planning appropriate approaches to patient needs. This understanding informs and expands the education and practices of a culturally competent nurse.
Nursing Theorists: Hildegard Peplau
HILp=help Within the relationship with my patients, how can I best help him/her understand his/her health problems and develop new, healthier behaviors? Relationships (Nurse and patient)
Test-taking
Have a comprehensive study system- pre-reading, hearing the lecture, making rough notes during lecture, reading the printed material, making your final set of notes, reviewing at least twice, and self-testing. The true-false approach (shows the relationship between two things, ideas or procedures. Looking for ONE best answer on multiple choice questions. Negatively-worded questions require the one best answer. Clinical vignettes- point up the relevance of your basic science education to clinical practice; thumbnail sketch of patient's problems
Definition of cultural competence
Having an awareness of one's own cultural identity and views about differences, and the ability to learn and build on the varying cultural and community norms of patients and their families. It is the ability to understand the within-group differences that make each patient unique, while celebrating the between-group variations.
Nursing philosophies
A philosophy is a set of beliefs about the nature of how the world works. A nursing philosophy begins to put together some or all concepts of the metaparadigm
Why are theories important?
1) Nursing is strengthened when nursing knowledge is built on sound theory 2) Theory is a useful tool for reasoning, critical thinking, and decision making (goal is to support excellence in practice)
Theories represent what?
Abstract ideas rather than concrete facts and new theories are always being generated
Nursing behaviors and attitudes demonstrated by a culturally competent nurse (2)
A nurse who identifies how personal beliefs and expectations can influence care is better able to recognize and deal with any prejudices that may impede patient care
Nursing Theorists: Ida Orlando
"Ida" "ADPIE" in Orlando or Interaction at Disney-world in Orlando How can I best figure out what my patient needs through my interaction with him or her? Developed ADPIE Interaction
Responsibilities of nurses to enforce professional boundaries, including the use of social media
1) A nurse must not post anything about their patients that may violate their rights to privacy and confidentiality. 2) Never post images of patients 3) Online contact with patients blues professional and personal boundaries 4) You are ethically obligated to report any breach in confidentiality or privacy that you encounter online 5) Remember that post anything leaves a digital footprint forever.
Informed Consent
1) Consent must be given voluntarily 2) Consent must be given by an individual w/the capacity and competence to understand 3) The patient must be given enough information The nurse may witness a patient signing, but is NOT responsible for explaining the treatment
Strategies nurses can use to protect their patients, thereby protecting themselves from legal actions
1) Practice in a safe setting (has policies, procedures, and personnel practices that promote quality and safety; has safe equipment) 2) Communicate with other health professionals, patients, and families (must be open and clear; accountability; documentation) 3) Meet the standard of care (be knowledgeable and safe; familiarize themselves with policies and procedures) 4) Carry and understand professional liability insurance 5) Promote positive interpersonal relationships 6) Delegate wisely, remembering the "five rights" of delegation
Reasons nurses are sued for malpractice (pg. 112)
1) Practice while under the influence 2) Failure to follow standards of care 3) Failure to communicate 4) Failure to document 5) Failure to assess/monitor 6) Failure to use equipment in a responsible manner 7) Failure to act as a patient advocate
Applying selected nursing philosophies and theories to patient situations (1)
1) Review your personal philosophy of nursing (your perspective about nursing practice that encompasses your beliefs, assumptions, and values; about the concepts important to nursing (i.e., nursing, health, patient, environment).
The elements of malpractice
1) the nurse has assumed the duty of care 2) the nurse breached the duty of care by failing to meet the standard of care 3) the nurse failing to meet the standard of care was the proximate cause of the injury 4) the injury is proved
Applying selected nursing philosophies and theories to patient situations (2)
2) Critically reflect upon your professional nursing practice philosophy so that you are clear on what you believe and value about nursing practice.
Applying selected nursing philosophies and theories to patient situations (3)
3) Review the metaparadigm concept definitions in nursing theories that you already suspect may agree with your personal philosophy or review theories that fit under the classifications of nursing that strike a chord with your beliefs (e.g., holism, healing, adaptation, energy fields, etc.).
Applying selected nursing philosophies and theories to patients situations (4)
4) Again, you are looking for the best fit between a theory and patient or client situations you encounter or are likely to encounter. Will the theory/model help guide your nursing actions and provide the best approach to the patient/client? Remember that there is no "right" way to practice nursing. You will likely use multiple theories in your daily nursing practice - find ones that fill in the gaps for your own practice.
Provisions of ANA Code for Nurses
8 revisions, each clarifying meanings, defining terms, and making the Code more relevant to nursing practice at the time. Also reflects trends in social awareness issues. 2015 (latest version)- the ANA is responsible for the periodic review of the code to ensure that it reflects the contemporary issues of this dynamic profession and is consistent w/the ethical standards of the society in which we live.
Dilemmas created by institutional and social issues
Health care institutions must be in compliance with many governmental regulations that affect both workers and patients. In turn, hospitals and other health care institutions implement their own policies of their institutions. Nurses may experience moral dilemmas when they disagree with the policies of their institutions. Ethics committees
Nursing behaviors and attitudes demonstrated by a cultrually competent nurse (5)
Being knowledgable about other cultures promotes feelings of respect and enhances understanding of attitudes, behaviors, and the impact of illness
Dilemmas regarding patients' rights
Consumers of health care are increasingly demanding to have a voice in their heath care decisions. A number of special interest groups have developed and published lists of patient rights. Patient Self-Determination Act Immigration and migration
Nursing behaviors and attitudes demonstrated by a culturally competent nurse (3)
Cultural assessment: Helps identify beliefs, values, and health practice that may help or hinder nursing interventions Asking a patient about their preferences. What they think or believe about their illness, their family structure, who providers should talk to in making decisions, and what the illness and its treatment means to them
Nursing Theorists: Dorothea Orem
DO it yourself What deficits does this patient have in providing his/her own self-care? Self-care
Dilemmas created by patient data access issues
Digital technologies and electronic health records are powerful sources for the storage and transmission of information about patients across health care specialties and disciplines. Technologies have created a digital portal into patients' confidential medical information, so those in positions to access health care information share a great responsibility to protect this information from unauthorized use.
Ethical dilemmas resulting from conflicts between patients, health care professionals, family members, and institutions
Dilemmas resulting from personal value systems, dilemmas involving peers' and other professionals' behavior, dilemmas regarding patients' rights, dilemmas created by institutional and social issues, and dilemmas created by patient data access issues
Stereotyping
In an effort to predict behavior, nurses may stereotype or make prejudgements about patients from different cultures. One size does not fit all. They are unconscious of their own innate values/beliefs and assume that all people are basically alike, that is, that all people share their values and beliefs
Grand theory
Is a broad conceptualization of nursing phenomena
Nursing conceptual models (framework)
Is a more specific organization of nursing phenomena than philosophies "Model" or "framework" - models provide an organizational structure that makes clearer connections between concepts
Middle-range theory
Is narrower in focus and makes connections between grand theories and nursing practice
How does culture affect personal beliefs about health and illness? (1)
Lack of understanding can create barriers that impede nursing care. When nurses work w/patients from cultures different from their own they lack familiar guidelines for predicting behavior, which causes anxiety, frustration, and feelings of distrust
Confidentiality
Legal and ethical concern. Protection of private information gathered about a patient during provision of care HIPAA
Nursing Theorists: Madeleine Leininger
Line across the globe (cultural) What are the best ways to provide care to my patient that are culturally congruent? Transcultural Theory; cultural care Culture
Malpractice
Malpractice occurs when a profession fails to act as a reasonably prudent professional would have acted under the same circumstances Caused mainly by negligence
Theory
Means that a person has some idea about a phenomenon and the way this phenomenon works in the word
Theory definition
Refers to a group of related concepts, definitions, and statements that describe a certain view of nursing phenomena (observable occurrences) from which to describe, explain, or predict outcomes
Ethical Principles (Principlism): Fidelity
Refers to faithfulness or honoring ones' commitments or promises Keeping nursing skills current
Nursing behaviors and attitudes demonstrated by a culturally competent nurse (1)
Refrain from stereotyping (one size does not fit all); individual planning is always the best basis for care Care that is NOT individualized can result in non-adherence to treatment plans, dissatisfaction with care, and suboptimal outcomes
Quality and Culture
Review the quality and culture quiz/answers (handout)
Code of Ethics
Shape professional self-regulation, serving as guidelines to the members of the profession, who then meet their responsibility as trustworthy, qualified, and accountable caregivers Practice w/compassion and respect Steps: 1) Clarify the ethical dilemma 2) Gather additional data 3) Identify options 4) Make a decision 5) Act 6) Evaluate
How does culture affect personal beliefs about health and illness? (2)
Stereotyping, communication difficulties, and misperceptions about personal space, differing values, and role expectations, ethnopharmacologic considerations, and ethnocentrism
Ethical Principles (Principlism): Veracity
Telling the truth, or not lying. Truth telling is fundamental to the development and continuance of trust among human beings
Virtue Ethics
Tendencies to act, feel, and judge that develop through appropriate training, but come from natural tendencies. This suggests that individuals' actions are built from a degree of inborn moral virtue
Principlism
Uses key ethical principles of beneficence (do good), nonmaleficence (do no harm), autonomy (respect for the person's ability to act in his/her own best interests), and justice in the resolution of ethical conflicts or dilemmas. Fidelity (faithfulness) and veracity (truth telling) are also important
Nursing Theorists: Virginia Henderson
Virgindependence What can I help this patient do that he would do for himself if he could? Independence
Licensure by Endorsement: Endorsement
the RN may practice in different states w/out having to take another licensing exam Proof of licensure in another state Licensure fee
Ethical Principles (Principlism): Non-maleficence
the duty to do no harm; nurses may not intentionally harm the patient Outcomes outweigh the harm
Ethical Principles (Principlism): Beneficence
to do only good Caring w/a desire to help others