Nurs. 104 Final
What are some examples of access of healthcare?
- cost shifting - PPACA - Medicaid
How are nursing skills recognized?
- nursing pins - registries
What is the minimum cumulative GPA required for admission into the 200 level nursing courses?
2.8
How much are the exams worth?
20% of final grade
What is the legal drinking age?
21
What were the regulations of practice in 1903?
4 states instituted permissive licensure, and nurses were not required to comply
What percentage of health care professionals are nurses?
40%
most advanced stage of HIV
Acquired ImmunoDeficiency Syndrome (AIDS)
legal title for nurses prepared by education and competence to perform independent practice
Advanced practice nurse (APN)
god of Medicine
Aescupius
- influences healthy policy and nursing practice - foremost recognized professional nursing organization for federal health and nursing public policy - speaks for all professional nurses, regardless of specialty - Nurses Strategic Action Team (N-STAT)
American Nurses Association
Which nursing organization elected their 1st black president in the 1970s?
American Nurses Association
professional organization that represents all registered nurses
American Nurses Association (ANA)
- emerged in the 50s - 1st nurses to be trained in college settings - more technical than critical - 2 year program in community colleges
Associates Degree (ADN)
- 4-5 years - "professional nurse" - include courses such as research, leadership, management, and statistics - 1st program at Yale in 1924 - usually required for admission to graduate programs - more BSN than ADN today
Bachelor's Degree (BSN)
Who started the Red Cross?
Clara Barton
an advanced practice nurse who is doctorally prepared and directs and participates in clinical research
Clinical Nurse Researcher (CNR)
- provides nutritional therapy and support to clients: dietary assessment, dietary teaching, identifying resources for food purchase and preparation, identifying areas of food-drug interactions
Dietician (RD or LD)
-PhD - DNS - DNP
Doctorate Degree
school teacher; during the Civil War, she was appointed to organize military hospitals and provide medical supplies; received no official status and no salary
Dorthea Dix
- Self-Care Deficit Model - self-care, self-care deficits, and nursing systems -goal and restore the client's self-care capability - purposeful nursing intervention
Dorthea Orem
Underground Railroad; 1st black nurse
Harriet Tubman
Theory of Caring
Jean Watson
provided funding for health care services for older adults and disables/renal failure
Medicare
What does PICOT mean?
Population Intervention Comparison intervention or group Outcome Time
- specify expected results (measurable) - competence (purpose of study/target to be reached) - learning to think like a nurse - outcomes include actions - validation of competencies - major incentive to promote patient safety and effective care - information gathering
Practice-Based Competency
ensures safe practice
Regulatory Boards of Nursing
- Does the theory relate to the scientific foundation from which it is derived? - Is it reflective of the scientific base?
Relevance
funded prenatal and child health centers staffed by public health nurses
Sheppard Towner Act
1st act to fund aid for women and children
Sheppard-Towner Act
- Does the theory provide a road map for replication? - Is it simple to follow? - Does it make sense?
Simplicity
What was the IOM's original publishing about quality care?
To Err. is Human: Building a Safer Health System
In 2001 John Hopkins created what?
Truth About Nursing
a brief overview of a research study
abstract
What were the health beliefs of the Prehistoric Period?
all natural phenomena; work of the gods
Nursing is considered a what?
art and science
combining two distinct cultures in a single region
biculturalism
What did the people of the Prehistoric Age use for health practices?
magic
an ethical principle stating the duty to not inflict harm
maleficence
When did the state legislation require nurses to become registered before entering practice?
the 1900-World War 1 period
In the 1990s what changed for nurses?
they had creative shifts (12 hours/3 days a week)
What happens to a student who earns a "D" or "F" in 2 or more required non-nursing courses?
will not be allowed to major in nursing at UL
What happens if your phone rings in the middle of the exam?
you will receive a 10% deduction from the exam grade
events within the hospital that are reasonably preventable
CMS Hospital-Acquried Conditions
-clinician with order writing authority sits at a computer to directly enter patient care orders -eliminates lost orders and illegal handwriting -prevents medical error
CPOE
-LACE report - there are for 4 roles
APRN
entity that is responsible for the specialized accreditation of nursing education programs, both postsecondary and high degree, which offer either a certificate, a diploma, or a recognized professional degree
Accreditation Commission for Education in Nursing (ACEN)
had acupuncture and believed in yin and yang on the basis of health
China
- not APRN - oversees the care coordination of distinct group of patients - expertise in quality improvement and cost-effective resource utilization
Clinical Nurse Leader
an advanced practice nurse who provides direct care to clients and participates in health education and research
Clinical nurse specialist (CNS)
- an EB guide to the clinical practice developed by experts in a particular field for direct application in clinical environment - gather, appraise, and combine evidence - make explicit recommendations - often define the "standard of care" - important role in guiding health care practices
Clinical practice guidelines as "standards of care"
system to classify diagnosis into similar groups and is used to determine the amount of Medicare payment to a healthcare provider
Diagnostic Related Group (DRG)
Match the names with the current position: Dr. Lisa Broussard: _________________________ Dr. Melinda Oberleither:___________________________ Dr. Deedra Harrington:___________________________________ Dr. Helen Hurst:____________________________________
Dr. Lisa Broussard: Associate Dean of the College of Nursing and Allied Health Dr. Melinda Oberleither: Dean of the College of Nursing and Allied Health Dr. Deedra Harrington: BSN Coordinator Dr. Helen Hurst: head of BSN and Graduate Program
The Renaissance and Reformation period is known as the __________ of nursing
"Dark Ages
belief in the people who are working to serve the customer
"all one team"
What are the core competencies of the 21st C.?
- critical thinking - communication - inter-professional collaboration - assessment - leadership - technical skills
What were the practice regulations in 1947?
- mandatory licensure - ANA formed the NCSBN
research focus, 1950's-1970's:
- teaching - administration - curriculum issues
What are some programs that were initiated in response to imperative to improve patient safety?
-TJC sentinel event standard -root cause analysis -TJC national Patient Safety Goals
What does the Institutional Ethical Committees do?
-provide ethics education -aid in policy development -serve as consultants to provide guidance in ethical dilemmas
What are some bioethical dilemmas for nurses in death?
-quality of life -cerebral vs. biological death -euthanasia/assisted suicide -end-of-life-decisions
What percentage of CRNA's are males?
41%
With Florence Nightingale's help during the Crimean War, the death rate went from ________ to _________.
42% to 2%
What is the lowest acceptable percentage to progress to the next nursing course?
77.00%
True of False: student responsibilities can be found in the Course Packet
False
What does HIPA stand for?
Human Insurance Portability and accountability Act
-health information and data -results management -computerized provider entry (CPOE) with or without decision support -clinical decision support -electronic communication and connectivity -patient support for patient education and home monitoring, when applicable -administrative process -reporting and population health management
IOM's core functionalities of the EHR
demonstrates scientific rigor to the audience when the research is disseminated either through presentation or publication
IRB approval
During WWI who were the surgical teams on the front lines?
Nurse Anesthetists
- each state develops their own laws to govern practice - ANA and later NCSBN provide a templet for nursing practice acts
Nurse Practice Acts (NPAs)
- enacted in 2010 - access to quality care service - ability to obtain/maintain affordable, credible health insurance coverage - Medicaid expansion
Patient Protection and Affordable Care Act
During the Middle Ages who was the central figure for health care?
Roman Catholic Church
What does STEEEP stand for?
Safe- preventing injuries Timely- reducing waste and delays Effective- services to those benefit Efficient- preventing waste Equitable- providing unvaried care based on personal characteristics Patient-centered- individuals needs, preferences, and values
a diagram or visual representation of concepts, conceptual models, or theory
Schematic model
- defined goals and objectives - commitment to work together - good communication - willingness to cooperate
Synergy
The National Student Nurse Association began what in 1993?
The Image of Nursing Program
When were nurses recognized as a profession?
WWII
Who defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"?
World Health Organization (WHO)
voluntary process by which schools of nursing are approved to conduct nursing education programs
accreditation
individual actively engaged in killing or attempting to kill people in a confined and populated area, typically through the use of firearms
active shooter
Why has telemedicine become more popular in recent years?
because of communication at internet speed
Why is the image of nursing important?
because our patients trust us to care for them
an ethical principle of compassion and patient advocacy, stating that one should do good and prevent or avoid harm
beneficence
Globally what is the number 1 noncommunicable disease killer?
cardiovascular disease
an idea or general impression; the basic ingredients of theory
concept
individual or group who relies on an organization to provide a product or service to meet some need or expectation
customer
collection and entry date into an EHR
data capture
- registering to vote and voting in all elections - joining a professional nursing organizations with policy, advocacy agendas - working in political candidates campaigns - meeting with policy or their staff members - attending "meeting the candidates" town hall meetings - communicating with policymakers by e-mail, fax, and telephone
grassroots political strategies
educational requirements imposed by individual states for renewal of a license
mandatory continuing education
What were some major advancements during the Renaissance and Reformation period?
pharmacology, chemistry, and medical knowledge
What should be your first response to an active shooter?
run
- a group of related concepts that explain existing phenomena and predict future events - an abstract generalization that presents a systematic explanation about how phenomena are interrelated
theory
What are the 10 Guiding Improvement Initiatives?
- Care is based on continuous healing relationships -care is customized according to patient needs & values -the patient is the source of control -knowledge is shared and information flows freely -decision making is evidence based -safety is a system priority -transparency is necessary -needs are anticipated -waste is continually decreased -cooperation among clinicians are priority
What are some computerized databases for research and evidence summary for EBP?
- Cumulative Index to Nursing and Allied Health Literature Information Systems (CINAHL) - Medical Literature Analysis and Retrieval System Online (MEDLINE)
What are the components of the HCAHPS Patient Experience Survey?
- HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems - economic issues and trends - implications for nursing
What organizations manage care?
- Health Maintenance Organizations (HMOs) - Preferred Provider Organizations (PPOs) - Point-Of-Service plan (POS)
What are the types of nursing degrees?
- LPN/LVN - Diploma - Associates - BSN - Masters - APRN - Clinical Nurse Leader
What are some government health insurance programs?
- Medicare - Medicaid - Veterans Administration
What is the ANA's firm and visible positions on health policy issues?
- Medicare and Medicaid reforms (APRN's direct reimbursement in these plans) - patient's rights - adequate reimbursement for health care services - comprehensive health care reform - access to health care - safe workplaces and health devices like safe needles, safe patient handling, and whistle-blower protection for health care workers
Different federal funding research programs:
- National Institute of Nursing Research (NINR) - Agency for Healthcare Research and Quality (AHRQ)
Who were the 1st states to implement nursing licensure?
- New York - New Jersey - Virginia - North Carolina
What are some Advanced Practice Nurses (APRN)?
- Nurse Practitioner - clinical nurse specialist - nurse anesthetist - nurse-midwife
What happened for nurses after WWII?
- Nurse Training Act of 1943 - State Board test pool - Hill-Burton Act
Examples of private research funding:
- Robert Wood Johnson - W.K. Kellog Foundation
What are some health policies that have influenced nursing practice?
- Sheppard-Towner Act - Hill-Burton Act - Nurse Training Act - Medicare Program - Renal Disease Program - Diagnosis-Related Groups - Balanced Budget Amendment - Nurse Practice Acts - Medicare Modernization Act - Mental Health Parity and Addictions Equity Act
Examples of nursing organizations for research funding:
- Sigma Theta Tau Institute - American Nurses Association - American Nurses Foundation - Specialty nursing organization ex. Oncology Nurse Society
What are some Quality Improvement buzzwords?
- Total Quality Management -Continuous Quality Improvement -Continuous Process Improvement -Statistical Process Control - Performance Improvement
What are some current health policy issues for health care reform?
- U.S. health policy initiatives to affect changes in how health is promoted and health care is accessed, delivered, and paid for - health care system issues
How can you create the image of nurses?
- act and dress apart - keep role boundaries clear - recognize benefit of organizations - deliver excellent patient care
What are the duties of the Boards of Nursing?
- administer the state's nurse practice act - grant and renewal of licenses and take disciplinary actions
What were the regulations of Nursing practice in 1896?
- attempts made to license nurses in the US - failed due to lack of broad-based support
How can the medical field achieve political influence?
- campaign activity and contributions - knowledge - relationships - information/data - talent - perceived control over large groups of votes
What are some professional nursing roles?
- care provider - educator - counselor - client advocate - change agent - leader and manager - researcher - coordinator of the interprofessional health care team
How does health policy work through regulation?
- carry force of law - directly shape implementation of health policy - must reflect the intent of the law as enacted by the legislative body - must be published and open to public comment for a specified length of time before being adopted as final rules - public hearings are held to allow interested individuals and groups to comment on the draft content of the regulations, suggest amendments of substitution, and final published regulations carry the force of the law and will dictate how the law is actually implemented
What are the nursing research roles?
- clinical nurse specialist - clinical nurse researcher - clinical nurser leader - doctor of nursing practice
HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems
- communication with nurses - communication with doctors - responsiveness of hospital staff - pain management - communication about medicines - cleanliness and quietness of hospital environment - discharge information - overall rating of hospital
Components of EBP Process:
- cultivate a spirit of inquiry - ask a PICOT question - literature review - critical appraisal - integrate best evidence with patient values/preferences - evaluate the outcomes - disseminate the knowledge
What are the stake holders in healthcare policy?
- elected officials - officials from governmental agencies - experts in the related area - corporate representatives - special interest group - affected citizens
What does the complex and dynamic process of health policy development include?
- enactment of legislation and accompanying rules and regulations that carry the weight of law - administrative decisions made by various governmental agencies - judicial decisions that interpret the law
What are some of the typical departments in the hospital?
- environmental services - administration - nursing - medical staff - admission and discharge - medical records - information management - quality improvement - infection control - evidence based practice - research - service or staff development
What are the nursing theories of the 21st Century?
- establish nursing theories will be re-evaluated and modified to answer important health care questions - will embrace complex issues as genetics, computers, noninvasive surgery, robotics, decreasing energy sources, increasing pollutants under a thinning ozone layer, environmental hazards, new diseases, and antibiotic-resistant illness
What are the purposeful nursing interventions of Orem's Self-Care Deficit Model?
- facilitates client self-care by measuring the client's deficit relative to self-care needs - implements appropriate measures to assist the client in meeting the needs by matching them with an appropriate supportive intervention
Types of funding for research:
- federal - private - nursing organizations
What are the benefits to EHR?
- financial incentives from the federal government to promote adoption -quality care, safety, and efficiency -continue of care
EBP encompasses multiple types of evidence:
- findings - reviews - EBP theory
What are some economic issues and trends?
- from illness emphasis to preventive emphasis - from acute care to preventive care, home care - from hospital or institution to non institution based (clinic or home) - from fee-for-service (cost based) to prospective payment and managed care - from physician directed to diverse decision makers and managed care - from if it might help, use it to outcomes measurement and cost effectiveness - from independent decisions (practice variation) to protocols and guidelines (best practice) - from local perspective (practice variation, standards, and benchmarking) to global perspective (protocols/guidelines/practice) - from introduction of new technologies (regardless of cost) to outcomes measurement and cost effectiveness - from paper records, medical charts to information systems, computer records
What are some health care system issues?
- growing uninsured population - barriers in access to care - health care disparities - rapidly rising costs - health professional shortages - concerns about quality and safety - a system focused on illness care rather than one that promotes health and wellness
Why is nursing theory important to practice?
- guides nursing practice and generates knowledge - describes or explain nursing - enables nurses to know WHY they are doing it & WHAT they are doing
What are the themes of the history of health care financing?
- health care decisions primarily by physicians - objective: "provide the best care to everyone" - rapid rise in sophistication and cost of medical technology - economic incentives & fee-for-service payment encouraged overuse of health care services
research focus, 1990s:
- health care delivery issues such as cost, quality, and access
What are some responses to increases in family plan premiums?
- high-deductible health plans (HDHPs) - health reimbursement accounts (HRAs) - health savings accounts (HSAs)
What are some of the traditional nursing roles?
- hospice - informatics - occupational - travel - case manager - flight nurse - forensics - school nurse - nurse educator - faith community nurse - telephone triage nurse - quality manager
What are the 5 steps of the Scientific Process?
- hypothesis - method - data collection - results - evaluation
What are the steps of Theory Acceptance?
- inclusiveness - consistency - accuracy - relevance - fruitfulness - simplicity
What is the PPACA's effect on the nursing profession?
- increase the supply of nurses with ever-advancing degrees, knowledge, and skills through accelerated nursing programs and APRNs filling a range of new roles in primary care, prevention and care coordination
What are the positive outcomes of PPACA thus far?
- increasing access & providing insurance protections (elimination of co-pay/deductibles for preventative services - elimination of pre-existing condition barriers & annual and lifetime caps to insurance plans - increasing reimbursements to primary care providers such as APRN's - educational mechanisms to rapidly grow the primary workforce
What are the areas of concern in the 21st Century?
- insufficient staffing - inadequate staffing - effects of stress and overwork - lack of participation in decision making - dissatisfaction
What are some out-of pocket expenses for private insurance?
- insurance premiums - deductibles - copayments
What are some educational issues and trends in nursing?
- knowledge expansion - practice-based - sociodemongraphics, cultural diversity, & economic & political changes - patient-centered care - shortage of nurses and faculty
What are the barriers to EHR?
- meeting guidelines is strenuous and costly -lack of interoperability (corporate competition) -EHR implementation cost
What are the special cases of nursing licensure?
- military and government - international education nurses - international practice
research focus, 1980s:
- more qualified researchers - widespread availability of computers for data collection and analysis - qualitative studies
What did the Social Security Act of 1935 do?
- national old age insurance program - federal grants to states for maternal and child welfare services - vocational rehabilitation for handicapped - medical care for crippled children and blind people - plan to strengthen public health services - federal-state unemployment system
What are the steps from novice to expert of Benner's clinical competence theory?
- novice - advanced - beginner - competent - proficient - expert
What are the interprofessional health care team members?
- nurse - physician - physician assistant - pharmacist - occupational therapist - speech-language pathologist - physical therapist - dietitian - respiratory therapist - social worker - chaplain or pastoral representative
What are the 4 roles of an APRN?
- nurse anesthetist - nurse-midwife - clinical nurse specialist - nurse practitioner
Research focus, 1900-1940:
- nursing education - student characteristics - student satisfaction
What are the different areas of specialty with a MSN?
- nursing educator - nurse practitioner - nurse anesthetist - clinical nurse leader - health care management
Why should the nursing profession be involved with health policy and politics?
- nursing practice is directly affected by health policy developed and health policy is affected by political action of citizens - nursing is the most trusted profession - national attention is being emphasized regarding nursing members, education, scope of practice and overall value to the health care system - RN are the largest occupation in healthcare
What are health issues related to lifestyles?
- obesity - alcohol - illicit drugs
What are some health issues of society today?
- obesity - smoking - alcohol - illicit drugs - opioid drugs - anti-microbial resistance (AMR)/ multi drug - resistant organisms (MDRO) - HIV - influenza - violence - terrorism - active shooter
Hospital's Medicare payments tied to scores on:
- patient safety - quality outcomes (how frequently patients have to be readmitted) - patient satisfaction surveys
What are some reimbursement methods for public insurance?
- pay-for-performance - never events - value-based purchasing
What are the federal regulations of the Personal Health Information (PHI) & Health Insurance Portability and Accountability Act (HIPPA)?
- personal health information (PHI) -privacy and security - HIPPA compliance and the student nurse
What is some examples of nature of violent acts?
- physical - sexual - psychological/emotional - involving deprivation or neglect - economic/financial abuse
What are the essential benefits of having insurance?
- preventive services - rehab services - hospital services - emergency services - lab services - ambulatory services - mental health services - substance abuse services - prescription drugs - maternity, newborn, and pediatric services
Health Care financing revolution:
- previous: retrospective fee-for service; incentives for more tests/procedures - shifted to: prospective payment system; incentive to reduce length of stay & minimize tests/procedures
What are the health care concerns of the 21st Century?
- primary focus on federal and state legislative agendas - major concerns: uninsured population, patient safety nursing shortage, rising health care costs, technology, confidentiality issues, and advanced nursing practice
How does politics affect nursing?
- process by which the decisions of others are influenced and control over situations and events are exerted - influence is the common denominator in any definition of politics - forms of political influence include money, knowledge, relationships, information, talent, and control over large groups of votes - groups and individuals who have a stake in the fate of a piece of legislation or the election of a candidate use political strategies to attain their desired outcomes - through effective political action, nurses can positively influence legislative decisions and health policies
What are the components of the Nurse Practice Acts?
- purpose of act - definition of Nursing and Scope of Practice - licensure requirements - renewal of license - mandatory continuing education
What does the certification of nursing licensure do?
- recognizes excellence - awarded by non-governmental agencies - other specialty organizations offer certifications examinations
What are some new methods of payment modes to control the cost and quality?
- reducing readmissions - provision of the PPACA established the Hospital Readmissions Reduction Program, which reduces Medicare payments to hospitals with excessive readmissions - nurses have a highly important role to ensure effective discharge planning and education so the patient and family are fully prepared to recover at home and prevent readmissions
What makes an RN a team builder?
- respect - cooperation - commitment - willingness
What are the benefits of nursing research?
- results provide foundation for practice decisions and behaviors - create strong scientific base for nursing - provide support for the quality and cost-effectiveness of interventions - application of results demonstrates professional accountability to insurers and health care consumers - generate knowledge in areas that indirectly affect nursing care process
examples of EBP:
- saline flushing - prevention and management of pressure ulcers-specific guidelines
What are the 3 broad categories of violence?
- self-directed - interpersonal - collective
What are some of the challenges nurses face in the 21st Century?
- serious nursing shortage - generational differences - high acuity and short staffing - conflict in the work place - health care access and cost
What were the practice regulations of 1950?
- standardized examination for licensure - National League for Nursing (NLN) administered the 1st State Boards Test Pool Examination
What are some preventive measures you can take for the flu?
- stay away from sick people - hand washing - covering mouth & nose with tissue when coughing - stay home if sick - get vaccinated
What are some bad images of nursing?
- tattoos - piercings - attire - attitudes
What is Excelisor College?
- the 1st college to have a distance-learning program for nursing - initially named the NY Regents External Degree Program - first started as an ADN program, then became a BSN program in 1976 - provides quality degree programs in many disciplines for adult learners unreserved by traditional programs - enrolls thousands
What is evidence-based practice?
- the process of systematically finding, appraising, and using - research findings as a basis for making decisions about patient care -integrates the best scientific evidence (research) with clinical expertise, patient preferences and values
What are some ways to locate published research and evidence summary for EBP?
- the world wide web - computerized databases - EB nursing - clinical practice guidelines
What are the 2 parts of Watson's Theory of Caring?
- transpersonal caring - holistic outlook
What are the team builders in the medical field?
- unit secretaries - nursing assistants - LPN's - housekeeping - security
What are the "cannons" or standards of the environment in Nightingale's Environmental Adaptation Theory?
- ventilation and warming - noise - variety - diet - light - chattering hopes and advice - cleanliness (health of the houses)
What are the federally defined minority groups?
-Asian American -Black/ African American -Hispanic or Latino -Native Hawaiian and other Pacific Islander -American Indian and Alaskan Native
What are some bioethical dilemmas for nurses in life?
-abortion issue -reproduction issue -Human Genome Project
What are the essentials of a Baccalaureate education?
-apply knowledge of social and cultural factors that affect nursing and health care across multiple contexts -use relevant data sources & best evidence in providing culturally competent care -promote achievement of safe and quality outcomes of care for diverse population -participate in continuous cultural competence
What are some ways that decision support was improved in the quality and safety of health care?
-automatic reminders about preventing practices - drug alerts for dosing and interactions - electronic resources for data interpretation and clinical decision making
What are the causes of death for minority groups?
-cancer -heart disease and stroke -chemical dependency -diabetes -homicides and accidents -infant mortality
What are the ranges of attitudes?
-hate -contempt -tolerance -respect -celebration -prejudice
What is the situation assessment procedure of the ethical decision-making model?
-identify the ethical issues & problems -identify and analyze available alternatives for action -select one alternative -justify the selection
What are some dilemmas created by technology?
-illnesses that once led to mortality are now manageable & are classified as chronic illness -cost is a consequence of prolonging life with technology -manipulation of DNA
What are some effects of people living longer?
-increased opportunity to develop chronic illness -social isolation and depression resulting from loss of family and friends -primary care providers faced with promoting maximum functional status and identifying risks to health and independence
What are some population trends?
-increasing in the number of immigrants -minority population will become the majority population -growth in the number and proportion of older adults is increasing and an unprecedented rate -longer lifespans and aging Baby Bloomers
What are some economic and social changes?
-jobless -homeless -poverty -limited access to health care insurance and health care -higher costs and lower wages for minority groups -more minorities lack health care and live in higher percentage of poverty -residential segregation -substandard housing -unemployment -poor physical and mental health -poor self-image -intimate partner violence (IPV)
What are some examples of marginalized populations?
-lesbian -gay -bisexual -transgender -other -recent immigrants from countries like Russia, Rwanda, and Afghanistan
What are some dilemmas for health professions?
-life & death -quality of life -right to decide -informed consent -alternative treatment issues -stem cell research -therapeutic & reproductive cloning -in vitro fertilization; donor insemination -surrogate motherhood
What are some cultural competencies in Nursing Education?
-mandatory for accreditation -RWJF new careers in nursing scholarship program -Doctorally Advancement in Nursing (DAN) project -nursing workforce diverse grants
What are some examples of NDNQI Safety Benchmarks?
-noise turnover rate -assault/injury rates - hospital readmission rates
What are the reasons for culturally competency?
-nurses's culture often differs from client's -culturally incompetent care is more costly -culturally incompetent care is ineffective -meet specific objectives for persons in different cultures as outlined by Healthy People 2020 -disparities in health and health care -nursing is committed to social justice -global infectious disease epidemics
What were the contributing factors to the IOM's original publishing on quality care?
-overuse of expensive invasive technology -under use of inexpensive care services -err-prone implementation of care that could harm patients and waste money
What are the 6 QSEN Competencies?
-patient-centered care -teamwork and collaboration -evidence-based practice -quality improvement -safety -informatics
What are some bioethical dilemmas in between life & death for nurses?
-questions of existence, reality, individual rights, responsibility, informed consent, cultural competence -right to healthcare
What are the Standards of Practice for Culturally Competent Nursing Care?
-social justice -critical reflection -knowledge of cultures -culturally competence in health care systems and organizations -patient advocacy and empowerment -multicultural workforce -education in training in culturally competent care -cross-cultural communication -cross-cultural leadership -policy development -evidence-based practice and research
.edu= .org= .com= .net= .gov= .mil=
.edu= educational institutes .org= nonprofit organizations .com= commercial enterprise .net= Internet service provider .gov= governmental body .mil= military
What is the legal blood alcohol level in Louisiana
0.08
When did the Community Mental Health Centers Act, Medicare, and Medicaid were passed by the state legislation?
1960s
What did Rome create in early civilization?
1st military hospital
How many days are we allowed to miss with an excused absence
2
Why was there a national shortage of nurses in the 1980s?
AIDS/HIV pandemic
- Does the theory explain retrospective occurrences? - Does the theory maintain its capacity to predict future outcomes?
Accuracy
- improve health care outcomes/ reduce the risk of harm - transform research into practice/promote use of EBP - advanced use of information technology for coordinating patient care and conducting quality and outcomes research - include priority populations health care needs in their research
Agency for Healthcare Research and Quality (AHRQ)
an independent agency of the ANA that conducts certification examinations and certifies advanced education and competence
American Nurses Credentialing Center (ANCC)
What were nurses known as in the 1930s?
Angel of Mercy
Who was an advocate for hospitals and care for the sick?
Benjamin Franklin
value-based purchasing; hospital impatient Medicare payments are reduced annually by 1-2%, hospitals can be reimbursed based on performance skills; Value= quality measures+ patient experience+cost of care
CMS
- serious, costly errors in health care that should NEVER happen - can cause serious injury or death to the patient
CMS "Never Events"
reasonably preventable
CMS Hospital-Acquired Conditions
U.S. Medicare Program; requires quality management in "conditions of participation"
Centers for Medicare and Medicaid Services (CMS)
What are some regulatory organizations for advancing quality?
Centers for Medicare and Medicaid Services (CMS) state licensing authorities require quality management activities and set quality standards
Why did Nightingale's graduate students migrate to the US?
Civil War
a subsidiary of the American Association of Colleges of Nursing (AACN) with responsibility for accrediting baccalaureate and higher-degree nursing programs
Commission of Collegiate Nursing Education
Where is the office of disability services located?
Conference center
the act of limiting, disclosure of private matters
Confidentiality
-second publishing by the IOM -30% of Americans failed to receive recommended care in 2010 -on average, patients are subjected to at least 1 medication error each day with high costs to patients, families, health care professionals, insurance companies, and hospitals -unprecedented advancement of science and technology -growing complexity of health care -changing public health care needs -poorly organized and uncoordinated health care delivery system
Crossing the Quality Chasm: A New Health System for the 21st Century
Who was the first nurse leader to describe the role of values clarification?
Diane Ustal
a defined set of EHR capabilities and standards that EHR systems must meet to ensure that their full capacity is realized and for the users (hospitals and physicians/ provider practices) to qualify for financial incentives from Medicare
EHR "meaningful use"
EHR systems that have the ability to share and transfer patient data seamlessly across health care systems and settings in a standardized manner that protects the reliability, confidentiality, privacy, and security of the information
EHR interoperablility
Who were the first people to suture and had a list of 700 or more drugs?
Egyptians
-system that captures, processes, communicates, secures, and present data about a patient -integration of information from multiple sources -services as a primary source of information for patient care and quality
Electronic Health Record (EHR)
the longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting; has the ability to support other care-related activity such as evidence-based decision support, quality management, and outcomes reporting
Electronic Health record (EHR)
-integrate best current evidence with clinical expertise and patient/family preferences and values -knowledge of basic scientific methods and processes -participate in data collection and other research activities -consult with clinical experts
Evidence-based practice
earliest literature reference of nursing
Exodus 1
- 1st nursing theorist - foundation for health promotion and guidance for the practice of professionals - Theory of Practice, Environmental Adaptation Theory
Florence Nightingale
- from Italy - born wealthy - "lady with the lamp" - Crimean War - created sanitary conditions - created patient records and document orders - created the 1st nursing school in England
Florence Nightingale
Mary Breckenridge started what?
Frontier Nursing Service
- Political Action Committee (PAC) -an arm of a corporation, association, or union formed to provide support and resources either to work toward the election or reelection of policymakers - may endorse a specific candidate for office - not all professional nursing organizations for this - endorsements of a candidate does not mean everyone in that organization must vote for that candidate
Grassroots Political Strategies (joint professional organizations)
hospital-acquired condition; a term used to indicate an unintended and typically adverse patient-acquired condition occurring as a result of being cared for in the hospital
HAC
disease that is transmitted through unprotected sex, transfusion of contaminated blood, sharing of contaminated needles, or between a mother and her infant during pregnancy, childbirth, & breastfeeding; pandemic outbreak in the 20th Century
HIV/AIDS
-the use of various forms of technology to improve the quality of heath services to individuals and communities -reduce costs -improve patient care quality and safety -technology advancements: influenced all populations including developing countries that have limited access to health care and widespread use of health information technology
Health Information Technology (HIT)
the use of various forms of technology to improve the quality of health services to individuals and communities
Health information technology
National Preventive initiative that focuses on improving the health of Americans by providing a comprehensive set of diseases prevention and health promotion goals and objectives with target dates
Healthy People 2020
hospital survey and construction act, provided federal funding for hospital construction
Hill Burton Act
In Greece, who was the first person to attribute diseases to natural causes; he is also known as "the father of medicine"?
Hippocrates
- oldest, most traditional RN program - modeled after Nightingale programs - appox. 2-3 years 1950-60s: increase in the number of hospitals led to the increase in the number of programs
Hospital or Diploma programs
retrovirus that infects cells of the immune system, destroying or impairing function
Human Immunodeficiency Virus (HIV)
National Academy of Sciences Institute of Medicine; a nonprofit organization with a mission of advancing and disseminating scientific knowledge to improve human health; the institute provides objective, timely, authoritative information and advice concerning health and science policy to the government, the corporate sector, the professions, and the public
IOM
- nurses should practice to the full extent of their education and training - nurses should achieve higher levels of education through an improved educational system - nurses should be partners, with physicians and other health care professionals, in redesigning U.S. health care - effective workplace planning and policymaking require improved data collection and information infrastructure
IOM: The Future of Nursing: Leading Change, Advancing Health
- explains the study - statements about potential risks and benefits - protection of anonymity and confidentiality, voluntary participation, compensation, alternative treatment, and specific information on how to contact the investigator - right to refuse to participate or to withdraw from study
IRB's informed consent signature
includes self-determination, privacy, anonymity, and confidentiality, fair treatment, and protection from discomfort and harm
IRB's protection of human rights
What country were the first people to preform surgeries, provide prenatal care, had hospitals with male nurses and vedas?
India
-set skills needed to find, retrieve, analyze, and use information -skills to equip the nurse in the timely retrieval of information necessary to plan deliver, and evaluate evidence based care
Information Literacy (IL) for Nurses
- accessed needed information effectively and efficiently -critically evaluates the procured information and its sources -uses information effectively to accomplish a specific purpose - understands many of the economic, legal, and social issues surrounding the use of information -accesses and use information ethically and legally
Information Literacy Competency Standards for Nursing
-nonprofit organization -education resources for the prevention of medication errors -provides independent, multidisciplinary, expert review of reported errors -health care professionals across the nation voluntarily and confidentiality report medication errors and hazardous conditions that could lead to errors - offers Medication Safety Self Assessments to allow nurses and other healthcare professionals to assess the medication safety practices in their work setting
Institute for Safe Medication Practices (ISMP)
- examines research proposals to ensure ethical rights of participants are protected - protection of human rights - informed consent signature
Institutional Review Board (IRB)
methodology that simultaneously synthesizes several experimental and non-experimental research findings to provide a comprehensive understanding of the phenomena or interest
Integrative Research Review (IRR)
What were the regulations of practice in 1901?
International Council of Nurses passed a resolution that each nations and state examine & license its nurses
professional organization that represents nurses in countries around the world
International Council of Nursing (ICN)
- U.S. Supreme Court, federal district courts, and U.S. Circuit Court of Appeals - resolves questions regarding agency regulations that may affect policy
Judicial
Who was the first army nurse to be promoted to colonial in US army during WWII period?
Julie Q Flikke
- more than 50% of the uninsured have no regular source of health care - uninsured individuals are twice as likely to delay or ignore needed care, less likely to receive preventive care services, more likely to be hospitalized for avoidable conditions, more likely to use the emergency department for nonemergency care
Kaiser Family Foundation Findings
-shortest program - most restricted - must work under the supervision of a RN - can't perform all skills - limited work in critical areas - practice focus on technical skills -NCLEX-PN licensing program
LPN/LVN
- public perception of the problem - definition of the problem - societal consequences of action or inaction - the number of people affected by the problem and/or solution - degree of support from other members of Congress, special interest groups, business leaders, and the general public, especially their constituents - degree of opposition from other members of congress, special interest groups, business leaders, and the general public, especially their constituents
Legislation and Health Policy Development
- Senate and House of Representatives (Congress) - possesses the sole federal power to enact legislation, tax citizens, & allocate federal spending - power to override a presidential veto
Legislative
pioneer in public health nursing; developed the 1st nursing services for occupational health, founder of the American Nurses Association
Lillian Wald
served as a nurse for 6 weeks until stopped by ill health; authored detailed accounts of the experiences encountered by nurses during the war for a newspaper publication, Hospital Sketches
Louisa May Alcott
a regulatory board of nurses that grants and renews Nursing licenses and disciplinary actions against a nurse who violates nurse practice acts
Louisiana State Board of Nursing
from Jamaica; Crimean War; worked with Nightingale; bought her own supplies and traveled to Croatia; built and opened lodging houses to nurse sick soldiers
Mary Seacole
a disaster situation that results in a large number of victims who need the response of multiple organizations
Mass Casualty Incident (MCI)
different areas of specialty
Master's (MSN)
- provides health insurance coverage to impoverished families, particularly those with children - primary prayer of long-term care nationwide - fastest growing component of many states' budget
Medicaid
federal largest insurance program; based on age or disability rather than need; people 65 and older; have end-stage renal disease; and eligible disability
Medicare
Television movie about nurse Ever's who participated in Tuskegee experiment studying syphilis in African American men
Miss Ever's Boys
What did the people of Palestine use during early civilization?
Mosaic Code
bacteria and other microorganisms that have been developed resistance to antibiotic drugs; ex. include C-diff, MDR-TB, and CRE; found in healthcare settings; spread by hands; the ill and elderly, those in hospitals or long-term care facilities, people with AIDS, and with multitude chronic disorders are all at high risk; caused by poor infection control
Multi Drug Resistant Organisms (MDROs)
- establishes minimal levels of practice - granted and governed by legislative and administered through state boards
NCLEX
What was created in 1985?
National Center for Nursing Research at the National Institutes of Health
What were the practice regulations of 1982?
National Council Licensure Examination- Registered Nurse (NCLEX-RN)
organization whose membership consists of the boards of nursing of each state or territory
National Council of State Boards of Nursing (NCSBN)
-voluntary database, collects national data -link between nurse staffing and patient outcomes measurement program that allows comparison -measures of nursing quality among national, regional, and state hospitals of similar type and size
National Database of Nursing Quality Indicators (NDNQI)
measures are being used along with patient satisfaction scores and other select clinical measures "pay for performance" based on the quality of care, offers incentive to deliver services designed to improve patient outcomes, health plans pay physicians and hospitals more if they meet certain quality targets, hospitals may earn back the reduced payments or even exceed the original payment amount based on their performance results
National Hospital Quality Measures
-symptom science: promoting personalized health strategies - wellness: health and preventing illness - self-management: improving quality of life for individuals with chronic illness - end of life and palliative care: the science of compassion
National Institute of Nursing Research (NINR)
Who did the CMS work with to identify hospital-acquired conditions that were determined to be reasonably preventable and for which the additional cost of hospitalization for treating these conditions should be paid?
National Quality Forum (NQF)
- responsible for: taking histories, physical examinations, ordering, performing, interpreting diagnostic tests - prescribes medicine and treatments; prescriptive authority - education emphasizes pathophysiolgy and pharmacology
Nurse Practitioner (NP)
In the 70s, a master's degree became required for what?
Nurse Practitioners
President Lyndon B. Johnson; immediate assistance to all nurses
Nurse Training Act of 1964
- unifies nurses' political voices across the country to enact measures to enhance health care for all - empowers nurses by encouraging them to take action and make sure their opinions are heard and understood by Congress and the public - provides structure and coordination for nurses across the country to be involved in grassroots lobbying - an ANA program - thousands of nurses across the U.S.
Nurses Strategic Action Team (N-STAT)
- shift from "giving care" to "working with" the patient - increase in the number of medical errors leading to lawsuits - HIPA - medication errors
Patient-Centered Care: Engagement, Safety, and Privacy
-patient is the source of control -patient values -patient preferences -diverse cultures, ethnic & social backgrounds -respect and encourage individual expression
Patient-centered care
- stages of clinical competence - one of the most useful frameworks for assessing nurses' needs and different stages professional growth - proposes that expert nurses develop skills and understanding of patient care over time through a proper education background as well as experience
Patricia Benner
assessment and improvement of work processes while focusing on what customers need and want
Quality Improvement
created to support development of 6 competencies for nursing students and nurses
Quality and Safety Education in Nursing (QSEN)
-promote and support attitudes, behaviors, knowledge, and skills -comprehensive management strategy -recruit, retain, promote culturally competent staff -require and arrange ongoing cultural education -provide clients access to bilingual staff -inform of rights to interpreter service -translate and make available patient education material and signage -ensure appropriate interpreter services -ensure that primary language and race/ethnicity are incorporated into the organization's management information system -collect and use appropriate data and access needs and resources of the community -ongoing self-assessment of cultural competence -develop procedures to address cross-cultural ethical and legal conflicts -prepare and annual progress report related to CLAS
Recommendations Standards for Culturally & Linguistically Appropriate Health Care Services (CLAS)
What did the IOM discover for guiding aims of improvement?
STEEEP
- aging population (people live longer) - diverse population - increase in the number of people living in poverty, homeless, and/or uninsured - disrespect of others - domestic abuse of women and children - various forms of violence in homes, schools, and public places - obesity epidemic - nontraditional families
Sociodemographics, cultural diversity, and economic and political changes
known for her abolitionist and nursing efforts; was an advocate of clean and sanitary conditions for patients to heal
Sojourner Truth
hired to work in laundry; served as a nurse because of the growing number of wounded who needed care
Susie King Taylor
promote specific improvements in patient safety with the goals highlighting problematic areas and evidence-based solutions to the problems with system-wide solutions wherever possible; identify patients correctly; improve staff communication; use medicines safely; use alarms safely; prevent infection; identify patient safety risks; prevent mistakes in surgery
TJC National Patient Safety Goals
-developed as an evidence-based teamwork system aimed at optimizing patient outcomes -helps improve communication and teamwork skills among health care professionals
Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)
A document written by The American Association of Colleges for Nursing (AACN) containing a set of core standards for baccalaurate-degree nursing education and provides direction for the preparation of professional nurses of the 21st Century
The Essentials of Baccalaureate Education for Professional Nursing Practice
T/F: Health care in the 60's and 70's was based of physician knows best and concept of "more is best"
True
T/F: The US department of homeland security recommends the following steps if active shooter in building (a) run (b) hide, (c) fight
True
- hospital reimbursement based on: patient experience of care: based on the hospital's scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HSAHPS), standardized patient satisfactory survey and clinical processes of care: examples include instructions for heart failure patients
Value-Based Purchasing (VBP)
Where is the nursing department located?
Wharton Hall
an ethical duty stating that one should be answerable legally, morally, ethically, or socially for one's activities
accountability
the process of becoming adapted to a new or different culture
acculturation
disease that effects every organ in the body; it is a central nervous system depressant; excessive use of this causes injuries, violence, liver diseases, and cancer, 3rd largest risk factor for diseases
alcohol
What were the practice regulations in 1923?
all states had instituted examinations for permissive licensure
In the colonies, what were the places called where individuals with infections diseases were isolated called?
alsmhouses or "pest houses"
concern for the welfare of others
altruism
What is considered an excused absence?
an illness, death in the immediate family, an athlete for UL who has a game out of town, an event with UL
What are some parts of ethical decision making?
answering difficult question and balancing science and morality
the cultural absorption of a minority group into the main cultural body
assimilation
-personal freedom and the right to competent people to make choices -self governance -the principle of respect for a person -the primary moral principle -concepts of freedom & informed consent
autonomy
personal freedom and the right of competent people to make choices
autonomy
-an ethical principle of compassion and patient advocacy, stating that one should do good and prevent or avoid doing harm -promote goodness, kindness, & charity -provides benefits to others by promoting their good
beneficence
dilemmas that pose a choice between perplexing alternatives in the delivery of health care because of the lack of a clear sense of right or wrong; nurses should consider the dilemmas that might arise in a given practice setting such as life and death
bioethical dilemmas
the study of ethical problems resulting from scientific advances
bioethics
the study of ethical problems resulting from scientific advances; has evolved with modern medicine; physicians, nurses, social workers, psychiatrists, clergy, philosophers, & theologians are joining to address ethical questions in health care
bioethics
Where are some places that have become the site of random acts of violence?
businesses, schools, & churches
What is the transpersonal caring of Watson's Theory of Caring?
caring among nurse, environment, and client is essential to healing
tool that is used for identifying and organizing possible causes of a problem in a structured format; it sometimes called a fishbone diagram because it looks like the skeleton of a fish
cause-and-effect diagram
process by which nurses are recognized for advanced education and competence
certification
attends to the spiritual and emotional needs of the client and family: pastoral counseling and support, sacramental ministry and liturgical celebrations
chaplain or pastoral representative
measurable items that reflect that quality of care provided and demonstrate the degree to which desired clinical outcomes are accomplished
clinical indicators
- prepared for specialty practice - expert clinician - educator - consultant - researcher -administrator
clinical nurse specialist
an evidence-based guide to clinical practice developed by experts in a particular field for direct application in clinical environments
clinical practice guideline (CPG)
An evidence based guide to clinical practice developed by experts in a particular field for direct application in clinical environments
clinical practice guidelines
a set of statements encompassing rules that apply to people in professional roles
code of ethics
infections and contagious disease; spreads from one person to another via airborne or bacteria, or also through blood or other bodily fluid
communicable diseases
a term of law; a state that has established an agreement with other states allowing nurses to practice within the state without an additional license
compact state
the results, or end products, of planned study and experience that are focused on specific abilities required for practice
competency outcomes
a group of concepts that are associated because of their relevance to a common theme
conceptual model
What happens to a student misses an exam because of a routine scheduled dentist appointment?
considered an unexcused absence and the student will not be allowed to make-up the exam
Can the theory address new entities without having is founding assumptions changed?
consistency
the problems, changes, and concerns that are current for the present time
contemporary issues
a variety of initiatives to ensure nurses' knowledge, skills, and expertise beyond initial licensure
continued competency program
subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured
control group
the essential cluster of abilities and skills required for competent nursing practice
core competencies
underinsured or uninsured health care debt that is transferred to the paying customer. The major factor leading to PPACA in 2010
cost shifting
unpaid costs covered by those who do pay- increases insurance premiums
cost shifting
a lifelong commitment to self-evaluation and self-critique, to redress the power imbalance in patient nurse dynamic
cultural humility
the first step to becoming a nurse who is culturally sensitive and competent health care provider
cultural self-assessment
What are some cultural assessments in health care?
cultural self-assessment; cultural client assessment; cultural client nutrition assessment; cultural beliefs about sickness and cures
incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-clinician dynamic, and to developing mutually beneficial and advocacy partnerships with communities on behalf of individuals and defined populations
cultural sensitivity
shared values, beliefs, and practices of a particular group of people that are transmitted from one generation to the next and are identified as patterns that guide thinking and action
culture
implement the step-by-step procedure that has been determined to answer the question
data collection
the process of acquiring existing information or developing new information
data collection
software programs that process data to produce or recommend decisions by linking with an electronic knowledge base controlled by established rules for combining data elements; the knowledge base and rules mimic the knowledge and reasoning an expert health professional would apply to data and information to solve a problem
decision support tools
-an ethical theory stating that moral rule is binding; -the end does not justify the mean -an approach that is rooted in the assumption that humans are rational & act out of principles that are consistent & objective & compel them to do what is right; -claims that a decision is right only if it conforms to an overriding moral duty & wrong only if it violates that moral duty; - persons are to treated as ends in themselves & never as means to the ends of others
deontology
an ethical theory stating that moral rule is binding
deontology
What is the responsibility for nurses within their profession according to the International Council of Nurses Code of Ethics for Nurses?
determine/implement desirable nursing practice standards and nursing education, develops a core of professional knowledge, active in professional organizations/promotes working conditions of nurses
What were the practice regulations in 1915?
due to the variability among states' licensure requirements, ANA designed "model nurse practice acts"
When did the Social Security Act of 1935 pass?
during the Great Depression
shifts in conditions and concerns that emerge from and influence various aspects of society; broad changes in the US and the world that influence the education and practice and other providers
education trends
the progressive movement from one type or level of education to another, often based on flexible, self-directed, or advanced placement options. Ex. RN-BSN, BSN-MSN
educational mobility
What is the holistic outlook of Watson's Theory of Caring?
effect and importance of altruism, sensitivity, trust, and interpersonal skills
having a foundation based on data gathered through the senses rather than purely through theorizing or logic
empirical
adaptation to the prevailing cultural patterns in society
enculturation
the capacity to decide with intelligence and compassion, given uncertainty in a care situation, with an additional ability to anticipate consequences and the courage to act
ethical sensitivity
science of study of moral values
ethics
the didactic and experimental process of developing ethical reasoning abilities as a part of ongoing professional preparation
ethics acculturation
affiliation resulting from a shared linguistic, racial, or cultural background
ethnicity
believing that one's own ethnic group, culture, or nation is best
ethnocentrism
a qualitative research method for the purpose of investigating cultures involve data collection, description and analysis of data to develop a theory of cultural behavior
ethnography
- examine the results to determine the relevance of outcome data in answering the hypothesis - determine the significance and identify the potential for future research
evaluation
research focus, 21st Century:
evidence based for practice
the process of systematically finding, appraising, and using research findings a the basis for clinical practice
evidence-based practice
- office of the President - recommends legislation and promotes major policy initiatives - has the power to veto legislation passed by Congress
executive
What are the 3 branches of the federal government?
executive, legislative, and judicial
a design that includes randomization, a control group, and manipulation between or among variables to examine probability and casualty among selected variables for the purpose of prediction and controlling phenomena
experimental design
What is the most used form of terrorism and why?
explosives because anyone can make them
a systematic process for identifying potential design and process failures before they occur, with the intent to eliminate them or minimize the risk associated with them
failure mode and effects analysis (FMEA)
the agreement to keep promises and commitments based on the virtue of caring
fidelity
What must a student do to be granted permission to engage in clinical nursing course?
file an application with the state board and have a criminal background history using fingerprints
- distance mobility programs - external degree model - makes it possible for adult learners to earn one of many degrees - known as the "classroom without walls"
flexible education mobility
picture of the sequence of steps in a process; different steps or actions are represented by boxes or other symbols
flowchart
Does the theory generate new directions for future research?
fruitfulness
-social media will develop into social platforms with more legitimate data sources than websites -cloud computing, applications accessed through the Internet, will dominate the computing world -improved technologies will help detect and sense emotions or how patients feel -telemedicine and mobile health will extend care to the home home environment after hospital discharges -gaming will expand health technologies by promoting health maintenance, physical activity, and cognitive skills for improved health behavior -smart watches will continue to expand their features and become as ubiquitous as smartphones -mobile technologies that promote health (mHealth) will continue to advance allowing patients and providers to communicate routinely -sensors and wearable technologies that monitor will continue to expand offering more options to continuously assess individuals
future technology trends
the inference that findings can be generalized from the sample to the entire population
generalizability
Who appoints the membership of the Boards of Nursing?
governor's office
statutory process by which previously licensed persons are included without further action in revisions or additions in nurse practice acts
grandfathered
proposal developed to seek research funding from private or public agencies
grant
a qualitative research design used to collect and analyze data aiming to develop theories grounded in real-world observations
grounded theory
What is information technology?
hardware and software that enable information to be stored, retrieved, communicated, and managed
In the 1940s nurses were seen as what?
heroines
What are some nontraditional nursing roles?
home health and ambulatory care
What is the 2nd leading cause of death among Americans 15-24?
homicide
respect for inherent worth and uniqueness of individuals and populations
human dignity
respect of inherent worth & uniqueness of independent & population
human dignity
Another name for the institutional review board
human subjects committee
- ask the question that is to be the main focus - usually includes independent and dependent variables
hypothesis
unlawful or illegal
illicit
includes opiates (heroin), cannabis (marijuana and hashish), cocaine, amphetamine; 200 million users globally
illicit drugs
- nurses are a major force in health care delivery: ensure positive patient outcomes and maximize reimbursement - efficiency and effectiveness of care: - expansion of technology - consumer empowerment
implications for nursing
Does the theory include all concepts related to the area of interest?
inclusiveness
In the 1970's the number of the indigent population _____________.
increased
The number of male nurses _____________ in the '70s.
increased
acute viral illness; several types; contagious; attacks the respiratory system; typically a seasonal illness (primarily in the autumn and winter months); an outbreak can take an economic toll; children that are younger than 5, adults older than 65, American Indians and Alaskan Natives, and people who have medical conditions are all at risk of obtaining this disease
influenza
-use information and technology to communicate -manage knowledge, mitigate error, support decision making -navigate the electronic health record -respond to clinical decision-making supports and alerts
informatics
interoperability of systems and linkages for exchange of data across systems
information communication
how data is viewed by health care providers
information presentation
decision support tools, reminders, access to guidelines
information processing
the hardware and software that enable information to be stored, retrieved, communicated, and managed
information technology
acting in accordance with an appropriate code of ethics
integrity
Practice and theory are __________________.
interdependent entities
-a must in today's information overloaded society -professional association and societies are a good starting point for professional information -scientific and research information usually requires literature resources that can only be formed in scholarly databases such as CINAHL
internet search
What is the most common type of injury in women between the ages of 15 and 24 across all ethnic, racial, socioeconomic, and educational groups?
intimate partner violence (IPV)
What happened to the healthcare costs in the 1970s?
it soared
the equal and fair distribution of resource-regardless of other factors
justice
the equal and fair distribution of resources, regardless of other factors
justice
Who used nurses in Egypt during early civilization?
kings
- major part of education and practice - information volume growing tremendously - ability to create, access, disseminate information rapidly is beneficial - communication at internet speed - smart phones access information quickly - telemedicine has become more popular - learn to select valid and reliable resources
knowledge expansion and use of technology
This process establishes minimal level of practice. Ensures public safety and each state determines rules and regulations
licensure
the original program whereby nurses licensed in 1 state seek licensure in another state without repeat examinations
licensure by endorsement
What is the responsibility for nurses in their practice according to the International Council of Nurses Code of Ethics for Nurses?
maintain competence/continual learning, maintains high standard of care, and uses judgement in accepting/delegating care
a subgroup of the population that tends to be hidden, overlooked, or on the outer edge
marginalized population
statistical method of quantitative synthesis of findings from several studies to determine what is known about a phenomenon
meta-analysis
interpretive translations produced from the integration or comparison of findings from qualitative studies
metasynthesis
- decide what data will be collected to answer the question - decide on and identify the step-by-step procedure that will be used to collect these data - make sure this process can be easily replicated
method
research design used to develop the validity and reliability of instruments that measure research concepts and variables
methodologic design
What is the average age of nurses?
mid-late 40s
an ethnic group smaller than the majority group
minority
forming a worldview & value system through an evolving, continuous, dynamic process that moves along a continuum of development
moral development
__________________ of the nurses in health care profession are in the hospitals
more than half
program developed by the National Council of State Boards of Nursing; the Nurse Licensure Compact program established interstate compacts so that nurses licensed in one jurisdiction may practice in other compact states without duplicate licensure
mutual recognition model
holistic view of nature and the direction of science that guides qualitative research
naturalistic paradigm
study in which the researcher estimates the resource needs of a group
needs assessment
serious adverse events during an impatient stay that should never occur or are reasonably preventable through adherence to evidence-based guidelines
never events
Do you need to report traffic violations with the State Board?
no, only arrests or other crimes
diseases that cannot be spread from one person to another; accounts for 70% of deaths worldwide
noncommunicable
-an ethical principle stating the duty to not inflict harm -to abstain of injuring others -to help others further their own well-being by removing harm and eliminating threats
nonmaleficence
- coordinator of the team - use the nursing process in client care in any health care setting: assessment, diagnosing (nursing diagnosis), planning, implementation (interventions- what you are doing to your patient), evaluation - specialty certifications for advance skills and/or degrees
nurse (RN)
- knowledgeable about both the business of health care and nursing profession - focuses on administration of health care systems to deliver services to patients - typically have Master's degree - serve at all management levels - lead and direct a large group of nurses - responsible for provision of quality care at reasonable cost
nurse administrator or nurse executive
provides anesthesia and anesthesia-related care most often involving surgical procedures
nurse anesthetist
-support overall management of patient care throughout length of stay -collaborate with other healthcare professionals to indicate changes -monitor ongoing effectiveness of care provided
nurse awareness for national hospital quality measures
- minimum of Master's degree in the specialty area in which they teach - competent in clinical practice at advanced generalist or specialist - expectations include teaching, scholarship, and service to the community
nurse educator
- primary care providers of women's health: pregnancy, childbirth, postpartum period, care of newborn, family planning, gynecological needs - care occurs in homes, birthing centers, clinics, hospitals
nurse-midwife
system of principles that govern the actions of the nurse in relation to patients, families, other health care providers, policy makers, and society
nursing ethics
What is the public's view of nursing?
nursing has topped the honesty and ethics list for 11 years
a systematic approach used to examine phenomena important to nurses and nursing
nursing research
the collection and organizations of data related to nursing and its associated components; the purpose is to provide a body of scientific knowledge
nursing science
the compilation of data that defines, and logically relates information that will explain past nursing phenomena and predict future trends; provides a foundation for developing models of frameworks for nursing practice development
nursing theory
excessive accumulation of adipose tissue and body mass index (BMI); issues has nearly tripled since 1975; preventable disease; causes an energy imbalance between calories consumed and calories expended; major risk factors in cardiovascular diseases, diabetes, musculoskeletal disorders, and cancer
obesity
plans activities that assist and teach clients with physical disabilities to become independent in activities of daily living: dressing, grooming, bathing, eating, daily responsibilities for home (housework), returning to work
occupational therapist (OT)
natural or synthetic chemicals that interact with nerve receptors in the body and brain, and reduce the intensity of pain signals and feelings of pain; 3rd leading cause of death; about 115 Americans die daily; Naloxone reverses the effects of the drug
opioids
What were the practice regulations of 1994?
paper and pencil test replaced by Computerized Adaptive Testing (CAT)
a graphic tool that helps break down a big problem into its parts and then identifies which parts are the most important
pareto chart
based on the health care provider's belief about what is in the best interest of the patient, belief about what is in the best interest of the patient, he/she chooses to reveal or withhold patient information such as diagnosis, treatment, or prognosis
paternalism
based on the health care provider's belief about what is in the best interest of the patient, he/she chooses to reveal or withhold patient information such as diagnosis, treatment, or prognosis
paternalism
QI is essential to improve safety and reduce health care errors
patient safety
-providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions -nurses, physicians, and other health professionals partner with patients and families to ensure that health care decisions respect patients wants, needs and preferences -developing care plans/discharge plans -providing education to make informed decisions -establishing "family advisory councils" to engage in decision making -incorporation user friendly technology to support patient education
patient-centered care
What is a challenge for nurses today?
patients today have a higher acuity
Medicare and private insurance reimburse providers based on quality of care; providers must meet standards of care for certain conditions such as diabetes and heart failure
pay-for-performance (P4P)
a process by which a scholarly work is checked by a group of experts in the same field to make sure it meets the necessary standards before it is published or accepted
peer-review
What was invented in the US from WWI-1920's?
penicillin and insulin
standardized evaluation based on objective demonstration of specific required competencies; used in conjunction with written tests of knowledge about those abilities
performance examinations
- provide drug therapy - drug information services - client and health care staff education - dispensing medications and clients monitoring - adverse drug reaction reporting - research - concurrent drug use evaluations - consultative service: pain management and nutritional support
pharmacist (RPh or Pharm D)
qualitative research design employing inductive descriptive methodology to describe the lived experiences of study participants
phenomenology
values and beliefs of the discipline
philosophy
-not a nursing care delivery model -should be incorporated as an essential component of any nursing care delivery model
philosophy of care
- attends the client's needs for movement - assessing physical strength & mobility needs - developing a plan of strengthening exercises - maintaining range of motion and muscle tone - identifying assistive devices that may be needed - may be an expert in the area of wound care
physical therapist (PT)
- works under the supervision of the MD or DO - the following must be approved by the physician: performs assessments, performs procedures, and performs protocols
physician assistant (PA)
conduct of a smaller version of a proposed study that develops or refines methodology prior to use in a larger study
pilot study
-technologies that allow real-time data retrieval, documentation, and decision support at the bedside or wherever direct care is provided - HIT directly at the bedside or within close proximity to where services are delivered - handheld computers, laptops, tablets, smartphones, and PDA's -Paramount to deliver safe, efficient, and quality patient care -easy access to patient data (past & present), references, policies, procedures, evidence-based literature -moves from practice that relies on memory to continuous use of resources as they are needed
point-of-care technology
research-based recommendations stated as standards of practice, procedures, or decision algorithms
practice guidelines
preconceived, deeply held, usually negative, judgement formed about other groups
prejudice
What is the responsibility of the nurse in dealing with people according to the International Council of Nurses Code of Ethics for Nurses?
primary responsibility is those needing nursing care, respect patient's values, customs, spiritual beliefs, and confidentiality of personal information
the right of a person to keep information about himself/herself from being disclosed to anyone else
privacy
Who began the Managed Care Organizations (MCOs)?
private insurance companies
a series of linked steps necessary to accomplish work
process
the differences in how the steps in a work process might be accomplished and/or the variables that may affect each step in the process; variation results from the lack of perfect uniformity in the performance process
process variation
a statement that proposes the relationship between and among concepts
proposition
Health care financing in the 1980's changed from retrospective payment system to a _____________ payment system
prospective
Which health care payment system incorporates diagnosis related groups?
prospective
-use data to monitor the outcomes of care processes -use improvement methods to design and test changes -continually improve the quality and safety in healthcare -describe approaches for changing processes of care
quality improvement
framework for taking action to systematically make changes that lead to measurable improvements in health care services for patients, staff, and organizations; quality is determined by the needs, expectations, and desired health outcomes of individuals and populations
quality improvement (QI)
Trends/issues in nursing education related to choosing the most effective electronic and technology option, information overload, and informatics in education and nursing practice
rapid knowledge expansion
admission to a hospital within 30 days of a discharge from the same or another hospital
readmission
written set of rules issued by the executive branch agency that has responsibility for administering a law
regulation
- a subset of EBP - the use of research knowledge, often based on a single study in clinical practice
research utilization
responsible for assessment and maintenance of the client's airway and respiratory equipment: client assessment, aerosolized medication adminisration (nebulizer treatments, inhalers), sputum sampling, arterial and mixed venous sampling (ABG's- arterial blood gases), pulmonary function testing, cardiopulmonary stress testing, sleep studies, pulmonary rehab programs
respiratory therapist
- on the conclusion of the data collection, statistically identify the outcomes - establish parameters that will determine whether the data are relevant
results
- payment method and economic incentives contributed to increased costs - the more tests or procedures performed, the greater physician's earnings because earnings tied to procedures - economic incentives to provide as much care as possible - patients insulated from costs because insurance was paying the bill
retrospective (fee-for-service)
the civil right that protects conscientious health care providers against discrimination, allowing them the right to act according to the dictates of their conscience
rights of conscience
the civil rights that protects conscientious health care providers against discrimination, allowing them the right to act according to the dictates of their conscience
rights of conscious
method of problem solving that helps to identify how and why events occurred
root cause analysis
graph of data in time order that helps identify any changes that occur over time; also called a time plot
run chart
- minimizes the risk of harm to patients and providers through system effectiveness and individual performance -use national patient safety resources -effective use of technology and standardization practices -examine human factors and basic safety design -values standardization practices that support safety
safety
- a method of bringing together facts and giving them coherence and integrity - dynamic and static
science
organizational support for all employees to develop knowledge and skills in the science of QI
scientific approach
access provided only to those who are authorized and have a legitimate purpose for its use
security
the means to control access and protect information from accidental or intentional disclosure to unauthorized persons and from alteration, destruction, or loss
security
an unexpected occurrence involving patient death or serious physical or psychological injury or the risk thereof
sentinel event
- caused serious issues - shortage of faculty - inadequate clinical staff- use of part-time agency nurses - fewer preceptors - qualified student applications denied admission - faculty are aging and retiring
shortage of nurses and faculty
highly addictive disease; chronic diseases include cancer, lung diseases, and cardiovascular diseases; kills 7 million people per year
smoking
acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation
social justice
uses skills to help clients, families, and communities address psychosocial needs: educating about community resources, discharge planning, financial counseling and identifying financial resources, crisis intervention, referring to community resources, abuse and neglect reporting, completing advanced directives, assisting with resolving ethical dilemmas, evaluating behavior and mental disorders, conducting support groups
social worker
- assists clients who are communicably impaired - intervening in speech, language, and/or swallowing disorders: receptive language, expressive language, speech ineligibility, voice disorders
speech-language pathologist (SLP)
approach to process improvement that involves developing and adhering to the best known methods and repeating key tasks in the same way, time and time again, until a better way to found, thereby creating exceptional service with maximal efficiency
standardization
assigning certain beliefs and behaviors to groups without recognizing individuality
stereotyping
the physical location of data
storage
What is the responsibility for nurses with their coworkers according to the International Council of Nurses Code of Ethics for Nurses?
sustains cooperative relationships, safeguards patient when safety is compromised by others
a group of people organized to accomplish the necessary work on an organization
team
-foster open communication -mutual respect -shared decision making -awareness of strengths and limitations as a team member -minimize risks associated with hand-off among providers
teamwork and collaboration
-telecommunications technology to assess, diagnose, treat persons who are located some distance from the interactive videos, and teleconferencing -home care arena has seen significant changes as a result -effective for those that may have difficulty accessing necessary services such as rural communities, older adults, or prisoners -telehome care devices; automated blood pressure monitors, weight scales, video monitors, etc. -real-time data capturing improves management of chronic diseases
telehealth
used to achieve political or social ends; intimidate opponents, or publicize grievances; uses weapons for mass destruction against civilian population; premeditated unlawful life-threatening; used throughout history in every part of the world; including kidnappings and hostage-takings, hijackings and skyjackings, cyber, and economic
terrorism
What are some ethical challenges in health care?
the challenge of veracity, autonomy, and accountability
-nurses have an obligation to uphold the highest standards of practice to assume full and professional responsibility for every action, and to commit to maintain quality in skills and knowledge base of the profession -obligation to denounce a harmful action or potentially threatening situation may fall to a fellow member of the profession; to remain silent is to consent to the action of the threatening situation
the ethical challenge of accountability
advance directives, consent or refusal of treatment; competency issues; minors, emergency situations, confused older adults, mentally compromised, inebriated, imprisoned, unconscious
the ethical challenge of autonomy
-an action and an attitude wherein the provider tries to act on behalf of the patient and believes that his or her actions are justified because of a commitment to act in the best interest of the patient
the ethical challenge of paternalism
-issues of alternative treatments & acknowledgement of uncertainty test truth-telling -Which treatment among 2 or more is best for the patient? -Which of the new drugs should be used?
the ethical challenge of veracity
a national agency that conducts surveys of inpatient and ambulatory facilities and certifies their compliance with established quality and standards; "gold seal of approval"; one of the 1st accreditation agencies to embrace quality improvement principles as an accreditation requirement in hospitals; organizations accredited by this agency receives a deemed status to automatically meet foundational approval from CMS; accredits more than 20,500 health care organizations; addresses the organizations level of performance in: patient safety, patient rights, patient treatment, infection control
the joint commission (TJC)
answers for improved patient safety require all care providers to pull together to review critical circumstances and learn from key events; nurses' challenge is to make patient safety a personal priority; 2 significant nursing functions closely influence patient safety and quality: monitoring for early recognition of adverse events, complications, and errors and initiating deployment of appropriate care providers for timely intervention and response/rescue of patients in these situations
the professional nurse and patient safety
What is the fundamental responsibility of the nurse according to the International Council of Nurses Code of Ethics for Nurses?
to promote health, to prevent illness, to restore health, and to alleviate suffering
What is the purpose of nursing licensure?
to protect the public
being grounded in one's own culture, but having the skills to be able to work in a multicultural environment
transculturation
The most common opportunistic infection in the patient with HIV
tuberculosis
an ethical theory stating that the best decision is one that brings about the greatest good for the most people
utilitarianism
an ethical theory stating that the best decision is one that brings about the greatest good for the most people; the end justifies the means; an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of bad consequences; the best decision is one that brings about the greatest good for the people
utilitarianism
Centers for Medicare and Medicaid services rewards inpatient hospitals for providing quality care to include patient satisfaction. What type of purchasing is this called?
value based purchasing
entire framework on which actions are based
value system
customs, ideas of life, and ways of behaving that society regards as desirable
values
a process by which people attempt to examine the values they hold & how those values function as a part of the whole
values clarification
an ethical duty to tell the truth
veracity
an ethical duty to tell the truth; trust factor
veracity
the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation; the leading cause of death among people 15-29;
violence
- the obligation to denounce a harmful action or potentially threatening situation committed by a colleague -the obligation to denounce is based on the fact that to remain silent is to be consent to the action or threatening situation -ex. chemical impairment, negligence, abusiveness, incompetence, cruelty
whistle-blowing
perspective shared by a cultural group of general views of a relationships within the universe; these broad views influenced health and illness beliefs
worldview
What happens if you arrive late to an exam?
you will be allowed to take the exam if no one has finished the exam and left the exam room