IPNL Test 3

Florence Nightingale

- 1st practicing epidemiologist - organized first school of nursing - improved sanitation in battlefield hospitals - practices remain a basic part of nursing today

Roles of the RN: Advocating for Client's Rights

- A common situation: Client's advance directives strongly opposed by family or healthcare team - prevention roles: educator and facilitator --- proactively educate client/fam about advance directives and facilitate advance care planning discussions - Intervention roles: dilemma resolution facilitator: --- consider client's preferences and wishes, state and federal laws, healthcare institution's policies, conflicting ethical principles, client/fam spiritual and cultural norms --- convene ethics committee

Today's Nursing

- Nurses and nurse educators are revising nursing practice and school curricula to meet the ever-changing needs of society, including an aging population, bioterrorism, emerging infections, and disaster management. - Advances in technology and informatics, the high acuity level of care of hospitalized patients, and early discharge from health care institutions require nurses in all settings to have a strong and current knowledge base from which to practice. - Nursing organizations and the Robert Wood Johnson Foundation (RWJF) are currently involved in programs to support nursing scholars, decrease the nursing shortage, and improve the health of the nation's population. - Nursing is taking a leadership role in developing standards and policies to address the needs of the population now and in the future.

Mother Bickerdyke

- Organized ambulance services during the civil war - responsible for establishing 300 field hospitals during the war - served as a lawyer assisting veterans and their families with obtaining pensions after the war

Ethical Guidelines

- listen to others - take action when ethical standards are violated - align personal and public actions with moral behaviors - maintain balance when defining success (also the way the results were obtained) - Consider the rights and best interests of all persons - Model fair and balanced decision-making - be trustworthy - regularly and proactively discuss ethics and values with co-workers - Ask "what is the right thing to do?" and "why?"

Atchley's Continuity Theory of the Spiritual Self

-- Deeper inner silence -- insight -- compassion -- connection with the ground of being -- transcendence of personal self -- wonder -- transformation

Why nurses neglect spiritual care

-- Failure to recognize spiritual needs -- Feeling inadequate to meet the needs -- Insufficient focus on spirituality in nursing education -- Belief nurse must be personally "religious" to meet the spiritual needs of the patient -- Personal discomfort by nurses discussing area that does not have concrete answers

Link between theory and knowledge development

-- Nursing knowledge is theoretical and practical -- goal of theoretical knowledge are to stimulate thinking and create a broad understanding of the "science" and practices of the nursing discipline -- experimental knowledge, or the "art" of nursing, is based on nurses' experiences in providing care to patients

prescriptive theory

-- address nursing interventions for a phenomenon and predict the consequence of a specific nursing intervention -- directs your interventions today -- very specific

Benner and Wrubel's Theory

-- caring is central -- creates possibilities for coping with stressors of illness

personal ethics

-- continuously intersect with other categories of ethics -- do not overlap perfectly; consequently a potential for conflict exists -- sources of ethics are not static and change over time

common attributes of culture:

-- culture is learned -- culture is changing and adapting -- shared beliefs, values, and behaviors

professional ethics

-- ethical standards and expectations of a particular profession -- held to a higher standard because of privileged role in society -- code of conduct -- aimed at the highest ideals of practice

failure to act or respond in an ethical way has been linked to:

-- serious and potentially dangerous errors -- personal stress -- professional burnout

common attributes of spirituality include:

-- spirituality is universal -- illness impacts spirituality -- pt./fam must be willing to share and act on spiritual beliefs -- Spiritual beliefs and practices are impacted by family and culture -- nurse must be willing to assess and integrate pt. beliefs into care -- nurse must be willing to consult with/refer to appropriate spiritual expert -- community-based religious organization can provide support/resources

14 basic needs of the whole person

1. breathing 2. eating/drinking 3. elimination 4. movement/positioning 5. sleep/rest 6. clothing 7. body temp. 8. hygiene 9. safety 10. communication/socialization/play 11. practice of faith 12. learning

Hildegard Peplau's Theory (Middle-range)

1952 Focus on interpersonal relations b/w nurse, patient, and patient's family DEVELOPMENT OF NURSE-PATIENT RELATIONSHIP Four Phases: 1. orientation 2. Identification 3. exploitation 4. Resolution

Virginia Henderson's Theory (grand)

1955 -- 14 basic needs of the whole person -- framing nursing care are the needs of the individual

Callista Roy's Theory (grand theory)

1970s -- views the patients as an adaptive system -- when patient cannot adapt to stressors, nursing is needed

Dorothea Orem's Theory (grand)

1971 focuses on patient's self-care needs goal is for pt. to manage their health problems

Betty Neuman's Theory (grand theory)

1974 -- based on stress and the patient's reaction to the stressor -- Role of nursing is to stabilize the patient or situation -- focus on the wellness and prevention of diseases

Madeline Leininger's Theory (middle-range theory)

1978 -- theory of cultural care diversity and universality -- considers social structure factors -- transcultural care

Jean Watson's Theory (grand)

1979 -- 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 -- transpersonal relationship that facilitates the patient's ability for self-healing

A law that defines the duty to report incompetent or unethical nursing conduct to the Texas Board of Nursing

Administrative law

Federal and state laws that permit U.S. citizens to pre-document healthcare goals, wishes, and preferences which have legal standing in the event the person becomes incapacitated

Advance Directives Laws

A federal law that protects the rights of people with physical or mental disabilities

Americans with Disabilities Act

the domain of nursing

Domain -- perspective of a profession -- provides the subject, central concepts, values and beliefs, phenomena of interest, and central problems of a discipline provides both practical and theoretical aspects of the discipline

Biculturalism

Duel pattern of identification

A federal law that requires emergency health care departments to treat/stabilize patients even if they are unable to pay

Emergency Medical Treatments and Active Labor Act

Which are true statements about the definition of spirituality in nursing? (Select all that apply.) Encompasses principle, an experience, attitudes, and belief regarding God Mind, body, spirit, love, and caring are interconnected Patient's quality of life, health, and sense of wholeness are affected by spirituality An exact definition was developed and adopted in the late 1980s Head knowledge affects spirituality more than heart knowledge

Encompasses principle, an experience, attitudes, and belief regarding God Mind, body, spirit, love, and caring are interconnected Patient's quality of life, health, and sense of wholeness are affected by spirituality

Clara Barton

Founder of the American Red Cross Cared for soldiers on the battlefield

Mary Mahoney

Graduated from the New England Hospital for Women and Children in 1879 Inducted into the American Nurses Association Hall of Fame in 1976

Harriet Tubman

Helped over 300 slaved to freedom in the Underground Railroad Movement

When completing the FICA tool for spiritual assessment, which questions should the nurse ask the patient? (Select all that apply.) How has your illness affected your personal beliefs? When was the last time you have been to church? What can I do for you? Are you connected with a faith center in your community? What things do you believe in that give meaning to life?

How has your illness affected your personal beliefs? What can I do for you? Are you connected with a faith center in your community? What things do you believe in that give meaning to life?

Fidelity

Keep promises

The nurse recognizes that which life events can be spiritually life changing? (Select all that apply.) Medical diagnoses Career day to day job duties Births Loss of independence Weddings

Medical diagnoses, births, loss of independence, weddings

Nightingale's Theory (Grand Theory)

Mid-1800s ENVIRONMENT as the focus of nursing care Descriptive theory

The Twentieth Century

Movement toward scientific, research-based practice and defined body of knowledge Nurses assumed expanded and advanced practice roles 1906: Mary Adelaide Nutting, first nursing professor at Columbia Teacher's College Army and Navy Nurse Corps established 1920's: Nursing specialization began

When conducting a spiritual assessment of a hospitalized patient, the nurse should remain aware of which potential barrier to effective communication? Multi-tasking while talking to the patient Listening to patients' complete statements Clarifying the meaning of a patient's statement Discussing patient's feelings while hospitalized

Multi-tasking while talking to the patient

A statutory law that describes and defines legal boundaries of nursing practice in each U.S. state

Nurse Practice Act

Lillian Wald and Mary Brewster

Opened the Henry Street Settlement, taking care of the health needs of the poor living in New York City tenements

A federal law that protects healthcare rights of U.S. citizens, promotes affordable healthcare coverage, and increases access to care

Patient Protection and Affordable Care Act

A healthcare institution's statement of minimum acceptable nursing care

Policy

Ethical standards and expectations of a profession

Professional ethics

When developing a plan of care, the nurse should consider which attribute of the concept of spirituality? Chronic versus acute illnesses affect spirituality Convincing patients to pray is a priority intervention Referrals may be needed to spiritual counselors Spirituality is not a well-known universal concept

Referrals may be needed to spiritual counselors

A 60-year-old Italian immigrant presents for an annual physical. He is counseled about diagnostic testing including laboratory testing, colonoscopy, influenza vaccination, and pneumococcal vaccination. His reply is "If it ain't broke, don't try to fix it." When developing a plan of care, the nurse should consider which cultural orientation for this patient?

Short-term orientation

8 Questions associated with the RESPECT model

What do you call the problem? What do you think has caused the problem? Why do you think it started when it did? What do you think the sickness does? How does it work? How severe is the sickness? Will it have a long or short course? What kind of treatment do you think the patient should receive? What are the chief problems the sickness has caused? What do you fear most about the sickness?

If a nurse decides to withhold a medication because it might further lower the patient's blood pressure, the nurse will be practicing the principle of:

accountability

A nurse is caring for a patient who states, "I just want to die." For the nurse to comply with this request, the nurse should discuss:

advance directives

Nursing theories provide nurses with perspectives from which to: A. Analyze patient data. B. Predict phenomena. C. Formulate legislation. D. Link science to nursing.

analyze patient data

The nurse is assessing a patient's spirituality and observes the patient meditating before any treatments. What is the nurse's best action? 1. Arrange for quiet time for the patient as needed 2. Limit the time patient can meditate before procedures 3. Offer the patient a copy of the bible to read 4. Document that the patient is not religious

arrange a quiet time for the patient as needed

The nurse is caring for an older Chinese adult male who is grimacing and appears restless after abdominal surgery. What is the nurse's best action?

ask the patient about pain and assess vital signs

Include clients in decision-making

autonomy

ethics of character

based on life experiences and a willingness to reflect on our actions

Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by:

bias, stereotyping, prejudice

Grand theory

broad in scope, complex, require specification

Ethical and moral decisions made in healthcare environments

clinical ethics

Ming is particularly drawn to the idea of becoming an advanced practice registered nurse (APRN). Ming's career options for becoming an APRN include which of the following?

clinical nurse specialist certified nurse midwife certified RN anesthetist certified nurse practitioner

ethnicity

common ancestry that leads to shared values and beliefs

Judicial decisions concerning individual cases, most of which relate to negligence and malpractice

common law

the role of the government is to protect human life, human dignity, and the common good

community and the common good

research ethics

conduct of research using humans and animals

theory

contains a set of concepts, definitions, and assumptions or propositions that explain a phenomenon -- guide the design of nursing interventions Nursing theories -- is a conceptualization of some aspect of nursing -- describes, explains, predicts, and/or prescribes nursing care generate nursing knowledge for use in practice, can direct how to use nursing process, and are adaptable to different patients and all care settings Goal of nursing knowledge is to explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines

RN's virtues of taking appropriate actions in response to ethically challenging situations

courage, compassion, commitment

What interrelated constructs facilitate a nurse to become culturally competent?

cultural desire, self-awareness, cultural knowledge, and cultural skill

clinical ethics

decisions made at the bedside

Descriptive theory

describe phenomena, speculate on why it occurs, and describes the consequences of it

Beneficence

do good

Non maleficence

do no harm

A paradox between two or more ethical principles

ethical dilemma

bioethics

ethical questions surrounding biological sciences and technology

You are in the process of admitting an ethnically diverse patient. To plan culturally competent care, you will conduct a cultural assessment that includes:

ethnohistory

Faith

evolving pattern of believing that grounds and guides authentic living and gives meaning in the present moment of interrelating

Interdisciplinary theories

explain systematic views of phenomena specific to the discipline of inquiry: -- basic human needs -- developmental -- psycho-social -- systems

Religiosity

external expression, in the form of practicing a belief of faith

Women who are given the job of caretaker for aging relatives are subject to caregiver strain due to: feminine attributes. unequal gender. fixed gender roles. female inequality.

fixed gender roles

organizational ethics

formal and informal principles and values guide the behavior, decisions, and actions taken by members of an organization directs all aspects of an organization

the sanctity of human life

human dignity

A student nurse employed as a nursing assistant may perform care:

identified in the hospital's job description

. Professional nursing specialty organizations seek to:

improve standards of practice expand nursing roles improve the welfare of nurses in specialty areas

The emphasis on understanding cultural influence on health care is important because of:

increasing global diversity

race

influenced by physical or biological characteristics

spirituality

internalized spiritual identity

Nursing process is central to nursing practice. Nursing Practice

is derived from a theory

ethics of consequence

is the greatest good for the greatest number

ethics of relationship

is the nature and obligation inherent in human relationships

ethics of duty

is the right thing to do

nursing paradigm

links person, health, environment/situation, and nursing

paradigm

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

Improper, illegal, or negligent professional activity or treatment

malpractice

nursing process

method of applying the theory or knowledge

Emotional disequilibrium that occurs when person acts in a manner that is contrary to personal and professional values

moral distress

Middle-range theory

more limited in scope (more specific) and less abstract

metaparadigm

most abstract overall, provides all the structure for the grand theory -- nursing, health, environment, patient

Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient's only treatment choice. This example describes the ethical principle of:

nonmaleficence

You are about to administer an oral medication and you question the dosage. You should:

notify the physician

Putting the needs of the poor and vulnerable first

option for the poor and vulnerable

All people have the right to participate in economic, political, and cultural life of society

participation

culture

pattern of shared attitudes, beliefs, self-definitions, norms, roles, and values that can occur among those who speak a particular language or live in a defined geographic region

Nursing is defined as a profession because nurses:

practice autonomy

Assimilation

process by which a person gives up his r her original identity and develops a new cultural identity by becoming absorbed into the dominant cultural group

Enculturation

process by which a person learns norms, values, and behaviors of another culture

Acculturation

process of acquiring new attitudes, role, customs, or behaviors

When teaching an Asian patient with newly diagnosed diabetes, the nurse notes the patient nodding yes to everything that is being said. With a better understanding of cultural interdependence in self-concept, a nurse should immediately:

prompt further to elicit additional questions or concerns

Societal ethics

provides a normative basis for ethical behavior with laws and regulations law is the minimum standard of behavior to which all members of society are held In nursing: -- clinical standards of care -- liability -- negligence -- malpractice

Understanding cultural differences in health care is important because it will help the nurse to understand the manner in which people decide on obtaining treatments and medical care. In independent cultures an individual will

put himself first

A patient uses rosary beads and attends mass once a week. This expression of spirituality is best described with which term? Faith Authenticity Belief Religiosity

religiosity

Every person has a fundamental right to life and a right to those things required for human decency

rights and responsibilities

If Ming decides to choose a career as a critical care CNS, then his specialty is identified by which means?

setting

concern for all peoples who live in the interdependent world

solidarity

Practice theory

specific theory to a specific thing, least abstract

Legal guidelines for defining nursing practice and IDing the minimum acceptable nursing care

standard of care

Ethics

study or examination of morality through a variety of different approaches

Veracity

tell the truth

Moral theory proposes the value of something is determined by its usefulness

utilitarianism