Nursing 100
Healthy People 2020
-increase quality and years of healthy life -eliminate health disparities (differences)
Spirituality
-inner strength related to belief and sense of connectedness with a higher power
Double effect
-justifying risking harm for a patients potential benefit (definition) *Action must be good or at least morally indifferent *Health care provider must only intent good benefits *Undesired effects cannot be a means to the end or a good effect *There is a favorable balance between the desirable and undesirable effect
neuroarthropathy
disease of nerves and joints
epilepsy
disorder in which the main symptom is recurring seizures
Termination or Adjourning
goals have been met, sometimes hard to let go of the group structure, time to recognize accomplishments
________ is defined as a very broad conceptualization of nursing phenomena
grand theory
Paternalistic
impose your own values on the patient; Share your values in such a way that the final decision is still based on your values
• Explain what malpractice is
improper professional action or the failure to exercise proper professional skills that result in injury, unnecessary suffering or death to the client.
Orientation or Forming
group comes together and gets to initially know one another and form a group, high level of anxiety for members but eager, members are polite but untrusting
Theories
group of related concepts, definitions, and statements theories guide nursing practice by describing, explaining, predicting, and controlling patient behavior and outcomes
Teaching a patient how to breastfeed her newborn infant is an example of which type of nursing intervention?
independent
Within the assessment stage of the nursing process, the nurse obtain's relevant ________ about the client's strengths and needs
information
hemophilia
inherited bleeding disease caused by a deficiency of the coagulation factor VIII
Implementation, the fourth step in the nursing process, is also referred to as _______ or _______
nursing interventions; nursing agency
Implementation
nursing orders/care plan is carried out
_________ is a designed series of actions intended to fulfill the purposes of actions of nursing
nursing provess
Values
principles, ideals, standards that give meaning and guidance
Define values
principles, ideals, standards that give meaning and guidance What's the right thing to do?
Nursing Process
results in an individualized plan of care for a patient, series of steps to developing appropriate nursing care, requires critical thinking, need format/blueprint
global society
seeing the world as one large community of multicultural people
HIPAA
• Privacy rule, federal law • Health insureance portability and accountability act- privacy rule, federal law 1996 • Purpose - protection of client health information
The fourth step in the nursing process is ___________
implementation
genetics
A competency - Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics (ANA, 2008)
Define role.
A set of expected behavior patterns associated with an individual's function within a particular group.
Hall
...
Resolution
4
Another name for pure science is?
Bench Science- information that is discovered but may not be useful yet
Derelict
Breach of duty, failure to meet the standard of care
Slander
Disclosing info orally
Social Systems
Do they have access to health care? Families, neighborhoods, poverty
Phase 3
Planning- goals and objectives
Caring
Treat me with respect, Listens to me with patience and understanding, Seems to care about my emotional well being, Has encouraged me to ask questions, Has made efforts to get to know me as a person
Battery
Unauthorized touching of another person
utilitarianism
Useful actions that bring about the greatest good for the greatest number of people. Ex: Triage in the Emergency Room treating the most seriously ill first.
Locus of Control
Where does your control come from? What I do as a person makes a difference in my health.
The nursing process
_________ describes significant actions taken by professional nurses to meet standards of practice
Nursing
__________ is the largest subculture of the healthcare system
mitral valve stenosis
a narrowing of the mitral valves from scarring, usually caused by episodes of rheumatic fever
Profession
a type of occupation that meets certain criteria that raise it to a level above that occupation. Requires high level of commitment and responsibility
Cause
breach of duty causing injury or allowed it to happen (let bed rail down, patient fell)
dysphasia
condition of difficulty in speaking
Clara Barton
founded Red Cross
_______ diagnosis guides medical management
medical
Much of one's message consists of _______ communication
nonverbal
intermittent claudication
pain and discomfort in calf muscles while walking. A condition seen in occlusive artery disease
Hard science is also known as
quantitative research
Depressants
- Alcohol - Sedative-hypnotic drugs : benzos opioids like heroin, opium, morphine (narcotics) - smoked, inhaled, injected by needle just under the skin ("skin popped"), or injected directly into the bloodstream ("mainlined")
Basic Elements/Components of Informed Consent
- Full Disclosure - Comprehension - Voluntary (without coercion) - Competency/capacity to make decision - Patient Self-Determination Act (1991)
Cannabis (relative of hallucinogens, but considered separate
- Hashish (solidified resin of the cannabis plant) - marijuana (THC)
Amphetamines (ex: Adderall, Concerta, Ritalin, etc.)
- Increase energy & alertness & reduce appetite when taken in small doses - Produce a rush, intoxication, & psychosis in high doses - Cause an emotional letdown as they leave the body - Stimulate the CNS by increasing dopamine, norepinephrine, and serotonin - History of amphetamines: pilots to stay awake -Used in diet pills in 1970s
What is Ludwig's System Theory?
A set of interrelated parts that come together to form a whole that performs a function. Each part is necessary or a component required to make a whole.
Level 3 of Kohlberg's Stages of Moral Reasoning (contains stages 5 and 6)
Postconventional Stage 5 - defines own moral code, human rights Stage 6 - highest level of moral development not achieved by all
What does the Institutional Review Board do?
Protects the rights of research subjects
Who defines nursing as a humanistic discipline which emphasizes the person's adaptive or coping abilities, including the need for alterations in the person's environment
Roy
Using _________ model in practice, nurses assess the environmental stimuli of both internal and external environments
Roy's
The ________ part of the diagnostic statement is the portion which explains for the defining characteristics of the disease
S (signs and symptoms)
S.O.L.E.R. Position
S-sitting squarely in front of patient O-open posture L- leaning forward shows interest E- eye contact R- relaxed appearance
Values
What is the standard for decision making and Derived from societal norms, religion, and family during the socialization process?
ANA - Professional Standard
What is the standard of care that the patient can except and the standard to which the expert witness will testify?
Standard 7: Professional Performance
What standard is this: 1. Evaluates own nursing practice in relation to professional practice standards, relevant state and federal statutes, and relevant administrative rules 2. Acquires and maintains current knowledge in nursing practice. 3. Considers factors related to safety, effectiveness, and cost in planning and delivering nursing care. 4. Nursing decisions and actions are determined in an ethical manner.
Ethical dilemma
When the underlying principles of an ethical system appears to contradict each other & no clear answer emerges
cerebral palsy (CP)
condition characterized by lack of muscle control and partial paralysis, caused by a brain defect or lesion present at birth or shortly after.
cerebral thrombosis
condition of a blood clot in the cerebrum
stages in human sexual response cycle
desire, excitement, orgasm, resolution
Implementation normally includes ________ the need
determining
Jewish doctors
developed a hygeine code o Beliefs: Disease is a curse r/t sin
neuroblast
developing nerve cell
The ________ operation of Orem's model determines the patient's ability to provide effective self-care
diagnostic
Comission
did something you shouldn't have
Reflection of Feeling
direct back what you sense a person is feeling, shows someone is trying to understand you, "I sense you feel worried."
Alzheimer's disease
disease characterized by early senility, confusion, loss of recognition of persons or familiar surroundings, and restlessness
leukemia
disease characterized by excessive increase in white blood cells formed in the bone marrow
Physicians: focus on _______________. a. patients b. bottom line c. disease cure/repair d. prevention and wellness
disease cure/repair
Rehab and Long Term Care
disease management, helping people live with chronic illness, use of all therapies, reach maximum health level
cardiomyopathy
disease of the heart muscle
lymphadenopathy
disease of the lymph glands. Lymphadenopathy syndrome (LAS) is a persistent generalized swelling of the lymph nodes often preceding the development of AIDS.
hypersensitive heart disease
disorder of the heart brought about by persistent high blood pressure
Sexual Dysfunctions
disorders in which people cannot respond normally in key areas of sexual functioning - Very distressing - Often lead to sexual frustration - Guilt - Loss of self-esteem - Interpersonal problems -Often dysfunctions are interrelated; many patients with one dysfunction experience another as well
varicose veins
distended or toruous veins usually found in the lower extremities
Under Watson's philosophy patient teaching can be carried out in a ____________ manner true to the caring realtionship
interpersonal
cerebrovascular accident (CVA)
interruption of blood supply to the brain caused by a cerebral thrombosis, cerebral embolism,, or cerebral hemorrhage. The patient may experience mild to severe paralysis.
In ________ the nurse acts in way to assist the client in reaching the goal
interventions
BAC = .09
intoxication
Evaluation
nurse looks at goals met-in progress-not met may result in continuing the care plan, revising it or discontinuing the plan of care
Diagnostic operations during Orem's model of nursing begins with the establishment of the _____________.
nurse-patient relationship
Duty
nurse-patient relationship is established care must meet legal standard
_______ diagnosis described the client's response to a disease or illness and is oriented to the individual
nursing
_______ diagnosis guides independent nursing activities
nursing
________ diagnosis changed as the client's response changes
nursing
During the __________ stage of the nursing process, the focus becomes treating the entire person, not just the disease
nursing diagnosis
During the nursing diagnosis stage of the nursing process, the nurse translates the history, physical exam and lab data collected during assessment into a ________
nursing diagnosis
Goal attainment during the planning stage of the nursing process reflects the resolution of the client problem specified in the ________
nursing diagnosis
The ________ expresses a professional judgment of a clitnet's clinical status, responses to treatment and nursing care needs
nursing diagnosis
The second step within the nursing process is _______
nursing diagnosis
________ is the basis for prescription of definitive therapy for which the nurse is accountable
nursing diagnosis
____________ defines the practice of nursing
nursing diagnosis
Under the nursing process, nurses benefit in receiving consistent and systematic __________
nursing education
Lavinia Dock
nursing education reform, women's suffrage
Korsakoff's syndrome
nutritional problem; neurological disorder caused by a lack of thiamine (vitamin B1) in the brain --> memory problems, apathy, lack of insight.. etc. caused from alchohol
• Identify barriers to effective listening
o Anxiety, stress, interruptions, too much to do, fatigue, hunger, anger
hemiplegia
paralysis of half (right or left side) of the body; cerebrovascular accident is the most common cause of hemiplegia.
monoplegia
paralysis of one limb
The ________ operation of Orem's model occurs when therapeutic self care requisites are determined and the nurse reviews various methods, actions, and priorities with the patient
presctiptive
Primary Prevention
preventing or slowing onset of disease, "teaching nutrition"
Secondary Care
prevents complications from disease (hospitals, home health, surgical units)
race
primarily determined by the biology of the person
Data which comes from the client themselves is known as a ________ source
primary
Battery
the actual intentional striking of someone, with intent to hrm, or in a rude and insolent manner even if the injury is slight.
Statutory laws
the body of law derived from statutes rather than from constitutions or judicial decisions
Assault
the threat of touching another person without his/her consent
Causes of Sexual Pain?
•Infection or disease •Physical injury - most commonly from childbirth! -This pattern is known medically as dyspareunia •As many as 14% of women suffer from this problem -Psychosocial factors & relationship difficulties alone are rarely responsible; but may contribute
• Identify the five most common medications associated with preventable medical errors
•Insulin •Opiates and narcotics •Injectable potassium chloride (phosphate) •Intravenous anticoagulants •Sodium chloride solution > 0.9%
DOCUMENT EVERYTHING
How do you defend due care?
Rehabilitator
The nurse administers rehabilitative activities along with members of other disciplines such as physical therapists to ensure that a client returns to a maximal state of functioning . o When clients experience alterations in health, the nurse's role is to promote client adaptation and coping.
society
The professional nurse makes a promise to...
In 1967 __________ identified the term "Nursing Process"
Western Interstate Commission
promote specific improvements in patient safety
What is the purpose of JCAHO's standards?
Those medical orders or interventions that are carried out by nurses a. Delegated b. Interdependent/collaborative c. Independent
a. Delegated
Formal Group
appointed or voted into the position, BUT doesn't mean other leaders emerge
________ is the first step within the nursing process
assessment
Values
attitude, beliefs develop over lifetime
Patient Sovereignty
base decisions solely on the patient's values
Self Efficacy
belief in your own abilities to change
Margaret Sanger
birth control movement
Plaintiff
bring the suit. must demonstrate an actual harm or injury resulted in breach in duty.
Goldmark Report
called for nursing education to be a separate from and precede employment- also advocated nursing licensure and proper training for faculty at nursing institutions
A poor listener fails to ________ a patient's unclear statement
clarify
A poor listener uses _________ and ___________
cliches; value statements
Position Power
comes from being in certain positions
Nonmaleficence
do no harm
Beneficence
doing good
Beliefs
ideas accepted as true
________ diagnosis remains constant
medical
• Discuss the impact of the therapeutic use of self on the nurse-patient relationship
o Nurses need to learn what the nurse-patient relationship really means o Nurse's therapeutic use of self o Care must be patient centered o Communication is critical
External Influences
-Culture -Past experiences
Who developed the theory of the therapeutic use of self or the nurse-patient relationship? A. Lillian Wald B. Hildegard Peplau C. Imogene King D. Mary Eliza Mahoney
B- hildegard peplau
Levels of impairment are closely tied to the concentration of ethyl alcohol in the blood:
BAC = 0.06: relaxation and comfort; BAC = .09: intoxication; BAC > .055: death
A research study that is sometimes referred to as "hard science" and that uses variable that are measurable A. Qualitative research B. Evidence based practice C. Quantitative research D. Moral reasoning
C- quantitative
cultural sensitivity
Capacity to feel, convey or react to ideas, habits, customs or traditions of a unique group
Stimulants
Cocaine Amphetamines Caffeine Nicotine
Obligation or duty
Deontolgy Immanual Kant
defamation
Either a false communication or a careless disregard for the truth that results in damage to someone's reputation.
What does input consist of?
Information, energy, matter entering the system that helps achieve the system purpose. ex: medications
Evaluation
Measuring how effective your care was
Tort
a civil wrong for which a remedy may be obtained in the form of damages.
This was introduced into medicine during the 20th century, leading to antibiotics, vaccinations & imaging) a. specialty units b. scientific method c. folk medicine d. spirituality
b. scientific method.
A critical thinker _______ effectively with others
communicates
Positive Attitude
confident, everything should turn out as it should, the world is a good place and just
NIC and NOC provide for the _________ of care
continuity
Slander
defamation of character in oral communication
Which philosopher emphasized a return to earlier values of nursing and emphasized the caring aspects of nursing?
jean watson
anesthesia
loss of feeling or sensation
dementia
mental decline
A critical thinker thinks __________ within alternative systems of thought, recognizing and assessing
open-mindedly
Scientific Method
orderly, systemic way of thinking about and solving problems
Morals
standards of conduct that represent the ideal in human behavior = how individuals ought to treat others
Paraphrase
state in "own words" what client said, checking perception
Nursing encompasses a ____________ process, which assists individuals to promote health, prevent illness, and cope with death. a. medical b. growing c. therapeutic d. frustrating
therapeutic
chief of staff
work together with the CEO to make important decisions about medical policy and and physican discipline for the institution
ANA's standard on confidentiality
"The nurse has a duty to maintain confidentiality of all patient information..."
Ethical Decision Making Model
*Clarify the ethical dilemma *Gather additional data *Identify options *Make a decision *Act *Evaluate
ANA's standard of justice
"...unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems"
ANA's standard on privacy
"The nurse safeguard the patient's rights to privacy. The need for health care does not justify unwanted intrusion into the patient's life. The nurse advocates for an environment that provides for sufficient physical privacy, including privacy for discussions of a personal nature, and policies and practices that protect the confidentiality of information"
Beneficial disclosures
# of births, deaths, STD's
Abdellah
...
Libel
A legal charge for defamation of character (damaging someone's reputation) commuted in a written form
What is the definition of health?
A state of being in complete physical, mental, et social well-being. DOESNT MEAN AN ABSENCE OF DISEASE.
Ethics
A system of principles (fundamental truths) a society develops to guide decision making about what is right & wrong; it helps people deal w/ difficult & complex problems that lack easy answers.
• Discuss the relevance of the core competency: Apply quality improvement
-Identify errors & hazards -Implement basic safety design principles -Measure quality of care -Design and test interventions
Basic learning principles
-Learning environment: allows person to attend to instruction
Watson
...
Widenbach
...
Two Types of anorexia nervosa:
1) Restrictive type - lose weight by cutting out sweets, fattening foods, eventually nearly all food; no variability in diet 2) Binge/Purge type
Match the term to the description: A Single Payer Plan: B. Socialized Medicine: C. Universal Health Care D. capitation: E. DRG Prospective Payment Sys. 1. pay certain amts of $$ for certain treatments 2. all would have access to health care 3. gov't not only pays, but provides 4. European, gov't pays for health care 5. you pay certain fee- provider takes care of you no matter the diagnosis (coop)
1-E,2-C,3-B,4-A,5-D
3 Strategies to Criticism
1. Acknowledgement: agreeing you need help/understand 2. Clouding: agreeing in part, something positive, be assertive still, defuses a win/lose situation 3. Probing: don't know if criticism is constructive or manipulative, confused
EBP 5 Step Process
1. Ask a Question (PICO) -Population, Intervention, Comparison, Outcome 2. Locate Resources 3. Critically Appraise Evidence 4. Make a Decision 5. Evaluate the Outcomes
Time management
1. Assessment/goal setting 2. Time analysis 3. Prioritizing 4.Evaluation
Levels of Perception
1. Selective Attention: concentrate on certain areas of an issue 2. Selective Exposure: type of message that we are used to "think like we do or judgement of others" 3. Selective Perception: individuals filter what they see and heat to suit their own needs and expectations 4. Selective Memory: information we retain from others interactions or experiences (requires remembering and forgetting)
Important concepts to systems to remember
1. whole system is different from and greater than some of its parts 2. set of intrarelated parts 3. a change in one part, creates change in all other parts 4. goal is balance (homeostasis)
Watson-10 Curative Factors
1.Human caring 2. Instill hope 3. Sensitivity 4. Helping-trusting relationship 5. Promoting and accepting positive and negative feelings 6. Problem solving to make decisions 7. Interpersonal teaching-learning 8. Supportive, protective environment 9. Assistance with the gratification of human needs 10. Allowance for interpreting existence in the world
Clinical Decision-making Process
1.Identify that client issue or problem exists 2.Analyze and interpret relevant data 3.Make inference based on this interpretation to determine possible causes 4. List all possible actions that could be taken 5. Evaluate each action and possible outcome 6. Select best action
Jean Watson propsed _____________ to differentiate nursing from medicine
10 caritas processes (Carative factors)
Mary Eliza Mahoney
1st African-American professionally educated nurse
Healthy People 2000/2010/2020
2 Goals 1. increase quality in years of healthy life 2. eliminate health disparities "differences" (want everyone access to healthcare)
The WHO estimates that ___ people worldwide consume alcohol.
2 billion
A medical diagnosis consists of ________
2-3 words
Orgasm
3
Peplau described a ____- prolonged process for the nurse to assist the patient in achieving personal growth
4
When people consume __ or more drinks in a single occasion, it is called __
5; binge-drinking
The nursing process came out in with ___'s
70
Communication and Patient Safety
70% of those deaths resulted from breakdown in communication Clear efficient communication = patient safety
What percentage of all teens and adults in the US display substance use disorders?
9%
Bulimia prevalence
90 - 95 % of cases are female Onset is between 15 - 21 years old *Of all psychiatric disorders, mortality rate is the second highest
Level 2 of Kohlberg's Stages of Moral Reasoning (contains stages 3 and 4)
: Conventional Stage 3 - makes moral choices based on what pleases others Stage 4 - makes moral choices based on what is good for society
Level 1 of Kohlberg's Stages of Moral Reasoning (contains stages 1 and 2)
: Preconventional (1976) *Stage 1 - self-centered *Stage 2 - responds to personal reward
Two requirements must be met to begin a malpractice claim on a nurse. Which of the following are necessary? A. Negligence applied to the acts of a professional B. The failed to document C. They gave someone the authority to act D. The prevailing standard of care was not met
A and D
ethical dilemma
A choice between conflicting values, there is more than one true choice, a choice between 2 equally unfavorable alternatives
Code of Ethics
A code of ethics is the philosophical ideals of right and wrong that define principles used to provide care.
Fraud
A form of dishonesty that involves cheating or trickery
Some therapists believe that the wisest course of action is simply to educate women whose only concern is lack of orgasm through intercourse. Why?
A lack of orgasm (Female orgasmic disorders) during intercourse is not necessarily a sexual dysfunction, provided the woman enjoys intercourse and is orgasmic through other means
Nurse's responsibility in relation to an informed consent?
A nurse may witness a patient's signing of informed consent documents. Professional nurses are responsible for determining that the elements for valid consent are in place, providing feedback if the patient wishes to change consent, and communicating the patient's need for further information to the primary care provider.
Care Provider
ADPIE Coordinates care, insures continuity Caring is the central concern to this role
the organization responsible for ethical codes and standards of nursing practice.
ANA
"The nurse participates in the advancement of the profession through contribution to practice, education, administration, and knowledge development."
ANA Code of ethics
Adaptation
Ability to change, grow and adjust
Malpractice
Act of negligence on the part of the professional
Damage
Actual harm or injury as a result
Battery
Actual willful touching of another person that may or may not cause harm.
acute vs. chronic illness?
Acute - severe symptoms that suddenly appear, progress steadily, subside quickly, patient returns to former level of functioning Ex. common cold Chronic - caused by permanent changes that leave residual disability; gradual development&ongoing, symptoms may be mild, vague, periods of remission, gradual onset of symptoms Ex. diabetes
Adverse Event
An injury caused by medical management rather than the underlying disease or condition of the patient. Ex. Brain damage to newborn because of lack of fetal monitoring or improper use of forceps • Lack of oxygen during surgery causing brain damage. May be incorrectly intubated or wrong gasses - cross of nitrogen and oxygen lines • ER loss of limb, brain damage or death because patient wasn't diagnosed and treated in timely manner. If patient had been seen - would not have had problems. • OR - improper positioning - nerve damage or ischemia to body part • Excessive amounts of anticoagulants and patient bleeds to death during surgical procedure
Assault
Any action that places another person in apprehension of being touched in a manner that is offensive, insulting or physically injurious without consent or authorization.
...protect the rights of the individual
Application of ethical principles in decision making serves to...
_____ science is the practical application of theory and laws
Applied Science
Practice of Nursing
Apply knowledge from biological, physical, and social sciences, nursing procedures and skills. Levels of knowledge, basic-foundational thinking, highest-critical thinking
How can you promote a positive image of nursing?
Appropriate nursing uniforms Communication Spread the word on what nurses do
How many men & women in US suffer from Sexual Dysfunctions?
As many as 31% of men and 43% of women in the U.S.
Threat or an attempt to make bodily contact with another person without the person's consent
Assault
Evaluation of Critical Thinking
Assess the relevance, significance or applicability of the findings to the situation
Miller's Wheel of Professionalism
At the center of the wheel is education, which should be a four year school
What is the main goal of a system?
Balance or homeostasis
Where should you position the interpreter?
Behind the patient
Protected individually identifiable health information
Blood type/Rh type Diagnosis of injury Date & times of treatment Diagnostic tests Lab results
Effects of Hallucinogens (psychedelic drugs)
Cause powerful changes in sensory perceptions (sometimes called "trips")
Security rule
Controls access by setting limits on the kinds of information systems health care providers can store records.
Nursing Theory Nursing is the Care, Core and Cure - Lydia Hall
Depicted by circles :The Care / Core / Cure Circles
Cocaine, increases what NT?
Derived from cocoa plant Increases dopamine at key receptors in brain (over-stimulating)
Collectively called genito-pelvic pain/penetration, causes?
Disorder are experienced by women much more often than men - Some women experience involuntary contractions called vaginismus. Causes: Cognitive-behavioral approach: learned fear response Other factors: anxiety/ignorance about intercourse, trauma by unskilled partner, CSA/sexual assault
Charting
Document care timely and accurately
Who wrote "Notes on Nursing: What is is and What is is not"
Florence Nightingale
Who's nursing philosophy focused on health, illness, and the nurse's role in caring for patients?
Florence Nightingale
Informed consent
Full, knowing, authorization by the patient for care, treatment and procedures and must include information about the risks, benefits, alternatives, side effects and costs. Consent must be given voluntarily by an individual with the capacity and competence to understand and the patient must be given enough information to be the ultimate decision maker.
Principles
Fundamental truths
Occupation
Group of jobs that are similar in the type of work and are usually found in an industry or work environment
Nursing Model Adaptation -Sister Calista Roy
Humans are adaptive systems that cope with change through adaptation Nursing helps patients' adaptation during health and illness assumption- the person is a bio-psycho-social person is produced by the environment. coping behaviors have to be used goal of nursing is to promote adaptation by managing the environmental stimuli.
Change Agent
Identify problems in care delivery, safety, and address these problems
Civil
Is tort law civil or legal?
Swanson's caring process as it relates to nursing
Knowing Being with Doing for Enabling Maintainig belief
Active Listening
Listening problems attending to what your person is say -Situational distractions: enviornment (IV pump) -Source distraction: what your person does (biting nails) -Bias/judging: assumptions and attitudes before facts -Listening anxiety: triggers inability to listen (so afraid what to say next)
Attitudes
Mental positions or feelings toward a person, object, or idea
6 skills for political competence
Nursing expertise Networking Powerful Persuasion Collective Strength Strategy Perseverance
Protect patient privacy
Require providers to protect patient confidentiality in all forms - oral, written, electronic
Occupational safety and health act
Requires employers to accept responsibility for the safety and health of their employees in the workplace
HIPAA
Before April 14, 2003 - can't overrule the state level. After April 14, 2003 more intense and gave penalties
Nursing Model Behavioral Systems Dorothy Johnson
Behavioral subsystems: Attachment, Dependency, Ingestive, Eliminative, Sexual, Aggressive, Achievement nurse assesses the client's needs in these subsystems. When the client is stressed the subsystems are disrupted. The nurse provides care the resolve problems in the subsystems to meet the client's needs.
Discreet
Being careful about what you say, preserving confidences & respecting privacy
Cultural Systems
Beliefs, customs, attitudes, religion, and beliefs about illness and pain
Values
Beliefs, ideal, & standards that provide the foundation for making decisions & guiding behavior.
1970: Human Sexual Inadequacy
Book written by William Masters & Virginia Johnson- Revolutionized treatment of sexual dysfunctions -This original "sex therapy" program has evolved into a complex approach •Includes techniques from cognitive, behavioral, couples, and family systems therapies, along with a number of sex-specific techniques
Professionalism
The demonstration of high-level persona, ethical, and skill characteristics of a member of a profession
Ethical principles: Beneficence
The doing of good
beneficence
The doing of good. Ex: Providing a sitter for a patient at high risk of falls to prevent injury.
Ethical principles: Nonmaleficence
The duty to do no harm
How has the history of nursing education affected the public's view of nursing as a profession?
The nursing career went from being viewed as cheap labor to providing high level education and specialized nursing areas
What does throughput consist of?
The processes a system uses to convert raw materials into a form that can be used. Processes used to make sense of the input. Focus on what your patient views as important!
provision 9 of the ANA Code of Ethics
The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy. (Assertion of values, The profession carries out its collective responsibility through professional associations, Intraprofessional integrity Social reform)
individual
The standards are based on the premise that the registered nurse is responsible for and accountable to the ____________ for the quality of nursing care he or she receives
Medicare
Title 18 of Social Security Act of 1965 Federal program, health care for people over 65, disabled, dialysis, or organ transplant There are deductibles, doctors don't always accept medicare patients
Medicaid
Title 19 of Social Security Act Federal and state program, differs from state to state, each state determines eligibility, healthcare for poor, hospital, medications, nursing homes
US lifetime % prevalence of Sexual Dysfunctions for both men & women?
US lifetime prevalence: 31 % men, 43% women
Comprehending information
Understand the knowledge retrieved, verbalize or use it in some manner, understanding is another term used for comprehension
"The registered nurse collaborates with healthcare consumer, family, and others in the conduct of nursing practice."
What do the standards of professional performance say about Collaboration?
Visual Learners
Written word, pictures, graphs, diagrams, mental visualizations, sit at the front of room, take detailed notes. Use charts, outlines, view videos, read books, place information on a timeline, organize notes in an outline
Which 2 factors would dramatically increase the amount of students able to enter the Nursing Program @ EMSON and other nursing schools while maintaining quality of students: a. hiring more qualified teachers b. lower the GPA requirements c. Providing more up to date space d. none of these.
a & c
Self-Awareness
a useful tool to the nurse as he or she serves others and gives of themselves and works with other people as a caring instrument
In which nursing era did religious communities staffed by monks/nuns provided care for the poor. a. Medieval Era . b. Modern Hospital c. 20th Century
a. Medieval Era
The power related by specific position and the responsibility associate with the position a. authority b. autonomy c. self-growth d. humility
a. authority
Motivation
ability to be enthusiastic in uninteresting work
What are the 5 steps within the nursing process?
assessment, nursing diagnosis, planning, implementation, evaluation
Empathetic Listening
attempting to understand and respond nonjudgementally, shows support, caring, warmth
This group, founded in 1894 as the American Society of Superintendents of Training Schools, changed its name in 1952 and publishes Training Guidelines. a. National Student Nursing Association b. National League for Nursing c. American Nurse's Association d. American Association of Colleges of Nursing
b. National League for Nursing
In nursing assessment, which is Objective data? a. "my chest hurts" b. Pulse Ox 84% c. "his father had COPD" d. none of the above
b. Pulse Ox 84%
aneurysm
ballooning of a weakened portion of an arterial wall
It's a discipline w/ a unique _______________ upon which diagnosis & treatment decisions are made. a. body of knowledge b. perspective c. scope of practice d. pay scale
body of knowledge
Boundary Crossings
brief excursions across boundaries that may be inadvertent, thoughtless, or even purposeful if done to meet a specific therapeutic need
If you wanted to get further education post-baccalaureate, Which of these would allow you to take new research and translate it into practice? a. Advanced Practitioner Nurse b. PhD c. DNP d. none of the above.
c. DNP
Which of the following should be avoided if you want to avoid legal problems? a. Use equipment as it should be used b. Identify errors and follow-up as designated by policy c. Do not talk to MD when you think the orders are questionable d. Document conversations with the MD, as appropriate
c. Do not talk to MD when you think the orders are questionable
Nurses today are ____________, political active, and powerful, especially when they unite. a. credentialed b. dominant c. autonomous d. goofy
c. autonomous
A nurse is taking care of a patient with a new diagnosis of metastatic lung cancer. The patient expresses a number of concerns: the cost of treatment, pain or her side, doesn't really understand why she needs chemotherapy, radiation, and surgery. The nurse provides comfort measures, administers ordered pain medications, informs the health care provider about the patients concerns, and requests a social worker consultation. This is an example of: A. Safety education B. Stressful communication C. Successful collaboration D. Communication breakdown
C- successful collaboration
BAC > .55
death
Libel
defamation of character in written communication
• Describe effective team functioning
o Collaboration, coordination, and communication • Work relationships with physicians • Mutually respect co-workers • Be someone who approaches problems with an open mind (Not I know better mindset). Work with others, not against others.
Explain how course syllabi can be used.
o School catalog and syllabus creates a contract.
Internal Factors Influencing socialization
own beliefs, values, religious beliefs
echoencephalography
process of recording brain structures by use of sound (also called ultrasonography)
Altruism
the nurse shows concern for the welfare of patients, other nurses, and other health care providers.
Assault
the threat or use of force on another that causes that person to feel reasonable apprehension about imminent harmful or offensive contact.
Responsible choice
there are choices, allows exploration of competing values
RT: improving _____________ & ___________ therapy. a. communication, verbal b. ventilation , oxygen c. cardiovascular health, aerobic d. respiration, hydration
ventilation & oxygen
Clarification
you don't understand what the client is saying, "Give me an example."
Intentional Tort
• Assault and battery • Invasion of privacy • False imprisonment • Defamation of character
o Five Rights
• Task • Circumstance • Person • Direction/Communication • Supervision
o High-tech care
• Technology's influence on health care will continue to increase • Nurses need to understand and know how to use technology • Nurses should be involved in its development and implementation • Concerns over increased technology • Need to keep in mind the potential for isolation and the need for effective communication, and must not forget the need for touch and face-to-face communication
October 16, 2003
Compliance deadline for electronic transactions & code set provisions
April 14, 2003
Compliance deadline for privacy & data security guidelines
The nurse is providing patient education for patient newly diagnosed with diabetes mellitus. When the nurse teaches the patient how to administer insulin, the nurse is demonstrating which phase of the nursing process? A. Diagnosis B. Planning C. Evaluation D. Intervention
D- intervention
The State Boards of Nursing provide all of the following EXCEPT: A. Grants schools of nursing approval to operate B.Set up and enforce minimum criteria for nursing education programs C. Protects the public from individuals without proper training D. Justify risking harm for a patient's potential
D-justifying risk harm for a patient's potential
Nursing Model Dynamic Nurse-Patient Relationship Ida Jean Orlando
Describes a model revolving around 5 interrelated concepts: function of professional nursing presenting behavior of the patient immediate reaction of the nurse nursing process for the patient
Nursing process: Planning (teaching)
Determine goals and expected outcomes that guide the choice of teaching strategies and approaches with a patient: Set priorities. Select timing to teach. Organize the teaching materials. Use teamwork and collaboration.
Researcher
Develop new knowledge, participate in research, plan interventions based on research
Legal Standard
Developed by the legislature and regulate standards of practice and education in each state; determined by each state and violation of these standards can result in suspension of license
Benefits of Service Learning
Developing civic capacity, leadership skills, self-awareness, sensitivity about vulnerable populations, communication skills
Secondary Acute Care
Emergency care • Acute medical-surgical care • Radiological procedures for acute problems (e.g., x-rays, CT scans)
2 ways to ID patients and correct patient gets correct blood
Explain the safety methods of identifying patients correctly
time out- SBAR, use in surgery where everybody stops and checks everything!
Explain the safety methods of identifying surgery mistakes
reconcile meds, give list to patient, family, regular MD, caregiver
Explain the safety methods to check patient medication
the purpose of the ANA Code of Ethics
Explains the primary goals, values, and obligations of the profession.
Assertiveness and the Challenging Patient
Express Empathy Describe Feelings State Expectations List Consequences
True or False: There are a no health care agencies in AR with union workers in nursing.
FALSE
• Explain how the IOM defines medical error
Failure to complete a planned action as intended (error of execution) or the use of a wrong plan to achieve an aim (error of planning)
censure or reprimand
Failure to uphold the code of ethics can result in...
TRUE/ FALSE. Kings model is linear; steps occur simultaneously as the nurse and the patient work together.
False
Who's nursing philosophy focused on the profession on person, health (as opposed to illness), and nursing (as opposed to medicine)?
Florence Nightingale
Nursing Knowledge
Focuses on knowledge needed for the care of clients, based on nursing research and research from other disciplines, evidence based practices use evidence from research for nursing best practices
Assertiveness with the Angry Patient
Identify the anger Give permission to be angry Give responsibility to patient to own anger Analyze the current situation that is disturbing patient Assist patient in plan to deal with anger
Process Standard
Identify what health care and nursing interventions are needed to deliver quality care; Focus on clinician or provider; i.e.: -includes nursing care techniques, procedures, regimen and processes -"the patient will receive Tylenol 500 mg every 4 hours for temp > 101 degrees F (assessment and intervention)"
• Identify JCAHO requirements for Sentinel events
JCAHO requires use of root cause analysis (RCA) to investigate the processes and systems that contribute to a sentinel event.
Community Systems
Job market, epidemics within the community,
Which branch disolves disputes and ammends common law
Judicial branch
Explanation
Justify the reasoning and conclusions drawn in relation to the evidence and contextual considerations
Carolyn McCarthy
LPN elected to US house leader on gun control
Level of research: Replicates earlier research begins independant research
MSN
Negligence applied to the acts of a professional Was the prevailing standard of care met?
Malpractice: Two requirements must be met to begin a malpractice claim Nurse has specialized knowledge or skill Through practice of that specialized knowledge or skill, the nurse caused the patient injury
Leader and Manager
Manage resources, ensure safe delivery of care, increase effectiveness and satisfaction with care
the importance of legal documentation in patient medical records
Medical records can be used in a court of law as evidence. It is important to document accurately and objectively when writing in patients documents.
Safety
Minimize risk of harm to patients and providers through both system effectiveness and individual performance. Examples: Examine human factors and basic safety design principles and commonly used unsafe practices. Value own role in preventing errors.
What Are the General Features of Sex Therapy?
Modern sex therapy is: - Short-term and instructive - Typically 15 to 20 sessions - Centered on SPECIFIC sexual problems rather than on broad personality issues
obedience to authority figure
Most nurses emphasize __________ _____ _______ __________ even when patient rights were being violated
"second-line" treatment for Erectile Dysfunction
Most other biological approaches have been around for decades - Includes: gels, suppositories, penile injections, and a vacuum erection device (VED)
Computer guidelines
Must be away from public Password protected Must be secure when not in use
Experimental
Needs a hypothesis and the purpose is to determine the effect of an intervention or compare two or more differing treatments.
Failure to act as a reasonably prudent person would have acted in the same circumstance
Negligence
Unintentional tort
Negligence and Malpractice
Malpractice
Negligence that occurs while the person is perfoming as a professional
Best to stay within scope of training
Never give info or perform duties your not qualified to do.
Shielding from harm, not discussing upsetting news and not tiring a patient were practices that were used under which philosopher's ideals?
Nightingale
Which philosopher believed that changing a patient's environment could positively effect their health?
Nightingale
Ensuring clean water and environment, adequate ventilation and a balanced diet were all important aspect under which philosopher's ideals?
Nightingle
Verbal and non-verbal communication do not match
Non Congruent Communication
Nonverbal communication
Nonverbal Personal appearance Posture and gait Facial expressions Eye contact Gestures Sounds Territoriality and personal space
nursing responsibilities related to informed consent and who can give it
Nurse goes and gets informed consent from patient for procedure it is the doctors responsibility to answer questions about the procedure and risk involved.
baccalaureate
Nurses prepared at the __________-level were linked with lower mortality and failure-to-rescue rates.
Virginia Henderson
Nursing practice is independent; self-help concepts; 14 areas of independence.
__________ theory specifies how patients are involved in the nurse's decision making
Orlando's
Respect autonomy
Patients have the to make own decisions
Informed consent
Permission given for a procedure to be performed after it & any possible consequences have been explained.
General requirements
Providers must comply All info must be secure Patients must be notified about their privacy rights Limited info must be distributed.
Dissemination of Findings
Publication Peer review Method that most journals use to determine if they will publish a study
Invasive procedure s
Punctures or incisions of the skin or insertion of instruments or foreign material into the body.
Patient-centered care Team-work and Collaboration EVP Quality improvement Safety Informatics
QSEN
Quantitative vs Qualitative
Quant- come up with statistical numbers and analysis Qual- measure human responses, feelings, and attitudes
What is the difference between quantitative and qualitative research?
Quantitative deals with measurable variables (Think Quanitity) Qualitative- measures the quality of the human experience. More of a soft science (think quality)
Root Cause Analysis
RCA is a tool that helps identify and clarify the bottom line factors that precipitate an error or near miss. RCA focuses on systems and processes, not on individual performance. •For each cause listed a "WHY?" question is asked and answered - ask 5 times
3. Dependence/mutuality
Reasoned appraisal; begins integration of facts and opinions following objective testing
Evidence Base
Reviews the strength of evidence in multiple research studies.
Autonomy
Self-determination
Common Characteristics of all definitions of professionalism
Service-Responsibility to society-alturism Specialized body of knowledge skills Autonomy Ethical behavior Professional commitment
professional nursing practice is influenced by standards of professional nursing.
Set of nursing actions constituting safe and effective client care agreed on by groups of nurses expert in their area of nursing
Evidence-based teamwork system designed through the agency for healthcare research and quality Teamwork system designed for health care professionals Provides higher quality, safer patient care Three phase process Phase 1-Assess the need Phase 2-Planning,Training, Implementation Phase 3-Sustainment
Tean STEPPS
veracity
Telling the truth, honesty. Example: The nurse tells the patient, "This injection is going to feel like a pinch but will only last a second."
Ethical principles: Veracity
Telling the truth, or not lying
Breach confidentiality
To break an agreement, to violate a promise
Authorization
To give permission for; to grant power to - consent
Paternalistic, Patient Sovereignty, "Shared"
What are three examples of Patient care decisions?
Communication, Collaboration, Support
What are three ways to keep moral distress to a minimum?
"The registered nurse communicates effectively in a variety of formats in all areas of practice."
What do the standards of professional performance say about Communication?
"The registered nurse practices ethically."
What do the standards of professional performance say about ethics?
"The registered nurse contributes to quality nursing practice."
What do the standards of professional performance say about quality of practice?
The danger of equating laws with ethics is that the minimum behavior (law) is taken to be the same as the ideal behavior (ethics).
What is the danger of equating laws with ethics?
choosing (beliefs)
What is the first step in valuing?
HIPAA
What is the legal standard for confidentiality?
Licensure
What is the legal standard in fidelity?
Poverty
_________ has become a culture of its own; it affects access to healthcare; the highest risk in US is children, older people, families headed by signle mothers, futurer generations of those currently living in ______
deep vein thrombosis
a condition of thrombus in a deep vein of the body. Iliac and femoral veins are commonly affected
Doctrine of res ipsa loquitur
a doctrine of law that one is presumed to be negligent if he, she, or an organization/employer had exclusive control of whatever caused the injury, even though there is no specific evidence of an act of negligence, and without negligence, the accident would not have happened.
patient's bill of rights
a document published by the American Hospital Association that if not followed by hospital, that institution could lose funding or reimbursement: • High quality hospital care • Involvement in your care • Help when you leave hospital • Clean safe environment • Protection of your privacy • Help with billing claims
sickle cell anemia
a hereditary, chronic hemolytic disease characterized by crescent or sickle-shaped red blood cells
person
a human being, constantly adapting to the environment biologically psychologically and socially
APRN
a licensed RN who is certified by a nationally recognized certifying body: • Certified nurse midwife CNM • Certified RN anesthetist CRNA • Clinical nurse specialist CNS • Nurse practitioner NP
gait
a manner or style of walking
magnetic resonance imaging of the head (MRI)
a noninvasive technique that produces cross-sectional and vertical images of cranial structures by use of magnetic waves. Unlike CT scan, MRI produces images without use of radiation or contrast medium.
Professional
a person who belongs to and practices a profession. A very misused term, ex: professional football player
Nurses need to work together, to develop a spirit of unity marked by ____________. a. activism. b. idealism c. union involvement d. magic markers.
a. activism
This role of a nurse _____________________, uses evidenced-based practice to care for individuals, families and communities a. caregiver b. teacher c. manager d. practitioner
a. caregiver
An ethical dilemma is a choice between two or more _____________________. a. equally undesired alternatives b. ethical theories c. possible solutions d. wrong choices
a. equally undesired alternatives
Omission
act of failing to provide proper care
Respect
all patients have inherent worth, dignity, unique
NIC and NOC can be used by nursing in _____ settings and ___ specialities
all; all
conscious
awake, alert, aware of surroundings
A nurse researcher is using human participants in a large teaching hospital and has submitted the proposal to the institutional review board (IRB). The nurse researcher can expect which of the following to be the role of the institutional review board? a-To assure the public the research is necessary and vital b-To ensure that informed consent is obtained from involved patients
b- to ensure that informed consent is obtained from involved patients
This was established during the Civil War to train nurses: a. Nurse Society of Philadelphia b. Army Corps of Nurses c. Army Corpsmen d. Dorothea Dix Training School
b. Army Corps of Nurses
which of these is NOT one of the 6 rights of delegation? a. Right information/directions/communication b. Right referral c. Right supervision d. Right follow-up
b. Right referral
As established by the State Board of Nursing, which element of delegation encourages nurses to avoid ruts? a. Tasks will be delegated with prior nursing assessment b. Tasks will not be routinely delegated c. Some tasks cannot be delegated d. all of the above
b. Tasks will not be routinely delegated
The freedom to make choices and decision b/c education, research findings, best practice guidelines a. authority b. autonomy c. self-growth d. Honesty
b. autonomy
Which of these is NOT one of the 5 primary of funding health care systems? a. direct or out-of pocket payment b. bartering c. general taxation d. social health insurance e. donation or free community health
b. bartering
HCFA spent $33.9 ____________ 1980 for Medicare and $24 _______________ for Medicaid. a. million b. billion c. trillion d. quadrillion
b. billion
Types of service for hospitals does not include... a. psychiatric b. recreational c. general d. pediatric
b. recreational
This role of a nurse________________________, provides health information during formal sessions and impromptu to individuals, families, and communities. . caregiver b. teacher c. manager d. practitioner
b. teacher
Specialized Knowledge
based on biological, physical, and social sciences, pathophysiology. Use this knowledge to promote health, prevent disease, empower others
"stop-start" or "pause" procedure
behavioral procedure for Premature ejaculation in which ...ch. 13
Philosophy of Nursing:
beliefs about nursing that demonstrate your values, used to make decisions
Values
beliefs that act as a standard for behavior
Subacute Care/skilled nursing care
between acute hospitalization and long term care, goal is to provide lower cost health care, requires multidiciplinary approach
Application of ethical theories
bioethics
Reprimand
board issued a letter for a minor violation of the Nursing Practice Act, with no restrictions on the license
chronic condition
by 2030, almost 150 million Americans (almost half) will have a ___________ __________
The nurse is concerned about bias during quantitative research. How can the nurse reduce the possibility of bias? a-Ensure all research subjects are the same age. b-Ensure all research subjects are the same gender. c- Ensure all research subjects are from a variety of backgrounds. d- Ensure all research subjects are in good health.
c- ensure all subjects are from a variety of backgrounds
Which of these is NOT a focus of the NCLEX? a. Safe & effective Care Environment b. Health Promotion & Maintenance c. Professional Responsibilities d. Psychosocial Integrity e. Psysiological Integrity
c. Professional Responsibilities
Mission: The mission of the Honor Society of Nursing, _______________________ is to support the learning, knowledge, and professional development of nurses committed to making a difference in health worldwide. a. Tappa Kegga Brew b. Nu Upsilon Rho Sigma Epsilon c. Sigma Theta Tau International d. IHOP
c. Sigma Theta Tau International
The profession of nursing, as represented by associations and their members, is responsible for articulating nursing ______________, for maintaining the ______________ of the profession and its practice, and for shaping _________ policy. a. needs, integrity, healthcare b values, humor, renumeration. c. Values, integrity, social d. standards, dignity, social
c. Values, integrity, socia
A certificate is usually bestowed by a ____________________ after course of study & upon completion of exam. a. state nursing board b. regional health care cooperative c. professional organization d. vending machine
c. professional organization
Primary characteristics
characteristics that are difficult to change, such as: o Nationality o Race o Gender o Color o Age o Religious affiliation
Paraphilias
characterized by intense sexual urges, fantasies or behaviors that involve objects or situations outside the usual sexual norms, including: -Nonhumans -Children -Nonconsenting adults -The experience of suffering or humiliation
Parkinson's disease
chronic degenerative diseases of the central nervous system. Symptoms include muscle tremors, rigidity, expressionless face, and shuffling gait. It usually occurs after the age of 50.
Tort
civil wrong against a person or a person's property (unintentional or intentional)
A ________ is a trite, stereotyped expression, and is common in social conversation but should be used carefully in professional relationships
cliche
embolus
clot or foreign material, such as air or fat, which enters the bloodstream and moves until it lodges at another point in the circulation
With a membership of approximately 50,000 nationwide, the ________________________ mentors the professional development of future nurses and facilitates their entrance into the profession by providing educational resources, leadership opportunities, and career guidance. a. American Nurses Association (ANA) b. Sigma Theta Tau c. The American Association of Colleges of Nursing (AACN) d. National Student Nurses' Association
d. National Student Nurses' Association
What country pays more per capita than the US does for Health Care? a. United Kingdom b. Japan c. Finland d. No other country pays more than the US.
d. No other country pays more than the US.
Antiandrogens
drug that lowers the production of testosterone Treatment for paraphilia; common side effect of lowered sexual arousa
Pharmacist: dispensing __________. a. advice b. prescriptions c. supplements d. drugs
drugs
Delegation
due to cost-cutting measures, in use of unlicensed personnel, responsibility relies within the RN, tasks delegated to lower staff, increase level of critical thinking and judgement
Legal Duties of the Nurse: Duties to the patient: a. give competent care b. give informed consent to treatments c. allow refusal of treatment d. provide privacy and confidentiality e. all of the above
e. all of the above
_________ is an important responding technique used by active listeners which consists of awareness of, sensitivity to, and identification with the feelings of another person
empathy
Focusing
emphasize a certain point, expand on a certain issue, "Let's go back and talk about..."
cardiomegaly
enlargement of the heart
splenomegaly
enlargement of the spleen
Everything nurses do must have ______________
evidence-based rationale
ethnicity
example Cajuns share cultural beliefs, doesn't have to do with race or nationality
Why be a member of a professional nursing association? a. To be a professional b. To keep abreast in political events and happenings affecting healthcare c. To be involved in nursing issues and to have a voice d. To network with peers e. To build your career & empower oneself
f. all of the above.
Production or Performing
group becomes effective in meeting objectives, involves time and increased disclosure among group members, members are open and trusting, flexibility is KEY and hierarchy of power is of little importance
arteriosclerosis
hardening of the arteries
congenital heart disease
heart abnormality present at birth
Mandatory Overtime
hours worked in excess of those agreed upon; Risks of making an error increase when work shifts are linger than 12 hours, nurses worked overtime, or when they worked more than 40 hours/week
Group Process
how an organization's members work together to get things done
Proxemics
how people use distance and space
parse
human becoming theory; personal meaning, rhythmic patterns, contrascending; emphasizes individual chooses patterns responsible for health; reaching beyond
Watson-10 Curative Factors
human caring, instill hope, use science to problem solve
Truth
i. Faithfulness to fact or reality ii. Attitudes 1. Accountability 2. Authenticity 3. Honesty 4. Inquisitiveness 5. Rationality 6. Reflectiveness
Autonomy
i. Planning care in partnership with patients ii. Honoring the right of patients and families to make decisions about health care iii. Providing information so patients can make informed choices and decisions.
congestive heart failure
inability of the heart to pump enough blood through the body to supply the tissues and organs
OSHA
includes working conditions, disposal, isolation procedures
_________ communication occurs when the words and non verbal communication do not match
incongruent
____________ communication creates confusion in receivers who are unsure which level of communication they should respond to: verbal or non verbal
incongurent
_________ interventions are activities which require no supervision or direction by others
independent
angiocarditis
inflammation of the blood vessels and heart
Confidentiality
insure the patients privacy
Giving false reassurance
it's ok
A critical thinker monitors, corrects and improves the _____
judgement
Expert Power
knowledge one person has
ataxia
lack of muscle coordination
Civil Law
law of private rights
Statutory Laws
laws enacted by any legislative body
Common Law
laws evolving from court decisions
Under the nursing process, nurses benefit in avoiding ______
legal action
Sexual behavior
major focus of both our private thoughts and public discussions
Hodgkin's disease
malignant disorder of the lymphatic tissue characterized by progressive enlargement of the lymph nodes, usually beginning in the cervical nodes
Tertiary Care
many levels of care offered, multidiciplinary approach (U of I, burn, psych)
Before the nursing process was developed, nurses tended to provide care that was based on __________ written by ___ and focused on specific disease conditions rather than on the person being cared for.
medical orders; MD
Fetishistic Disorder
mental health condition that centers on the employment of inanimate objects as a source of sexual satisfaction (slide 62)
Justice
merit, societal contribution, contribution in the free market, needs, least advantaged
_______ look at the patient themselves and care for their needs
nurses
A ________ diagnosis consists of a three part statement as described in NANDA
nursing
negative impact on the image of nursing
o Insecurity o Role confusion o Lack of professional confidence o Timidity o Fear o Sense of inferiority o Hospital policy o Perceived authority and directives of physicians o Historical role of nurses as handmaiden o Hierarchical structure of healthcare organizations o Threat of disciplinary action or legal action (afraid to speak up) o Nurse's silence may have negative impact on patient care
Colonial America
o Little infrastructure to support nursing o Catholic nursing orders and slaves provided care
• Explain the nurse's responsibilities with regard to informed consent
o Nurse must evaluate client understanding before witnessing the signature of the client on the informed consent form. o Physician is responsible for obtaining informed consent. o A client may withdraw consent at any time. o Parental consent (or legal guardian) should be obtained for minors (<18)
coronary occlusion
obstruction of an artery of the heart, usually from atherosclerosis (heart attack)
Secondary prevention
occurs after symptoms appear.
Provider can disclose ________ patient information
only minimum necessary
During which phase of the nurse-patient relationship is trust and respect developed
orientation
Communication Theory
process that is dynamic (changes) and ongoing, exchange of thoughts, ideas, information, collaborative if you need someone else, requires involvement, involves messages: different meanings for different people
American with Disability Act
prohibits discrimination as a result of disability, including mental illness, if the person can complete the job requirements.
Deontology
published by Emanuel, act is moral if it originates from good will, Rule: do no harm, duty to allow patient make own decision
A person who is a poor listener may give false _________
reassurance
Within the communication process the ____ receives the message
reciever
If a patient says " It's getting awfully warm in here." and the nurse responds " I'll adjust the air conditioning for you." They are only responding to the surface meaning which is failing to ________________
recognize levels of meaning
Civil Law
recognizes rights of individual "child support"
Illness Prevention
reduce impact of certain risk factors, address factors that already exist
anemia
reduction in the amount of hemoglobin in the blood
Public law
refers to the body of law that deals with relationships between individuals and the government and governmental agencies
Ethics
reflect the actions an individual should take or should be done
Active listeners use _________ in which they repeat what the client has said in question form
reflection
When the nurse uses ___________ they demonstrate understanding and acceptance while mirroring the patient.
reflection
Autonomy
right to determine own actions, make decisions, uniformed consent
Law
rule of conduct, formal authority to inforce
Morals
rules of conduct/deciding right or wrong
ateriorrhexis
rupture of an artery
Secondary Prevention
screening on early detection of disease
Data which comes from family, friends or significant others is known as a ________ source
secondary
For infants, young children and elderly with dementia data is generally collected from a ________ source
secondary (family, friends, significant others)
Therapeutic communication is directed toward the achievement of clear, mutually established, developmental, educative or preventative foals related to a _______
self-care defecit
Within the communication process the ____ initiates the message
sender
What are the elements necessary for communication to occur?
sender, receiver, message, feedback, context
Behaviors
serve the individuals needs and not group needs (self-centered roles) -Defensiveness: annoyed when people disagree with them -Intellectualizing: talks on and on about facts, likes to look smarter than others -Silent/nonparticipant: can avoid responsibility -Confused: never understand, so never has to carry load -Yes man: goes along with everything, uncommitted to issues -Blocker: always say no, or we tried and didn't work -Snob: my ideas are better than yours
IOM (Institute of Medicine)
serves as an independent, nonprofit organization that could undertake studies and use knowledge for advising government, federal agencies and other interested parties; ADVISOR
Using Peplau's theory the ________ determines which of the 6 roles are emphasized
setting
________ is a helpful tool used in nursing when people need to vent
silence
Henderson's Basic Needs
sleep, water, communicate emotions, worship, play
hemiparesis
slight paralysis of half of body
monoparesis
slight paralysis of one limb
encephalomalacia
softening of the brain
angiospasm
spasm (contraction) of the blood vessels
Numbers Power
specific to organizations, # of people in a group
Pastoral Care: _________ guidance/comfort. a. medical b. nursing c. spiritual d. cultural
spiritual
Kinesics
study of body movement, how someone carries themselves, hand gestures: movements that you make with hands and arms
Health Belief Models/Health Promotion Models
study or predict why people change their behavior and why others don't, based on beliefs, perceptions
Sample vs Population
subgroup from population
components of nursing interventions include:
subject - the nurse will verb- do something criterion
Components of the outcome/ goals include:
subject- the client will verb - action criterion of desired activity
A symptom is a type of _______ data
subjective
_________ data is data that is apparent only to the person affected and can be described and verified only by him/her
subjective
Both _________ and __________ data are gathered during the assessment phase of the nursing process
subjective; objective
cardiac arrest
sudden cessation of cardiac output and effective circulation which requires cardiopulmonary resuscitation
convulsion
sudden, involuntary contraction of a group of muscles
__________ data is private information
sujective
Economic Theory
supply and demand concept, influence amount and type of services provided, affect employment
Public/Government
supported by taxes, meet the needs of the community
Caring for self
survival as the goal; selfish
Under King's model, Care is guided by each of the _______
system levels
Evidence Based Practice
systematic process that uses current evidence extracted from research in making decisions about the care of patients, nursing practice that is based on nursing research
Expert Witness
testimony to the standard of care
Foundational thinking
the ability to recall and comprehend information and concepts foundational to quality nursing practice
Knowledge
the acquisition of facts and principles based on evidence and is considered to be the foundation of reason action. Acquired in classroom, online, clinical settings, other activities. Reinforced when applied in laboratory and clinical situations
patient outcomes
the implications of nursing education effect ________
chief executive officer (CEO)
the individual responsible for the overall operation on a daily basis
Informal Socialization
the learning experiences that occur incidentally, what you observe during your shadowing experience. Can be a positive or a negative experience. VERY powerful in the socialization process
ANA Standard 1
the nurse in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems
Standard 3
the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient
Teacher
the nurse provides clients and family members with information about health, treatment or therapy, and lifestyle changes. o the nurse determines if the client understands the information presented and reinforces the learning as necessary. o The nurse then evaluates the client's progress towards health-related goals. o The nurse uses teaching methods that are compatible with the client's knowledge, education, and literacy levels.
According to DSM-5, a diagnosis of paraphilic disorder should be applied only when...
the urges, fantasies, or behaviors: - CAUSE significant distress or impairment - the satisfaction of the disorder places the individual or others at risk of harm - either currently or in the past EX. people who initiate sexual contact with children warrant a diagnosis of pedophilic disorder regardless of how troubled the individuals may or may not be over their behavior
______________ is a goal-directed focused form of dialogue used as a tool in health care to promote a client's well being and positive response to treatment
therapeutic communication
Assault
threat to cause bodily harm
A nursing diagnosis consists of a _____________ as described by NANDA
three part statement
NIC and NOC facilitate collection of large databases used to study and effectiveness of nursing ________
treatments
Use of medications to treat sexual dysfunction is...
troubling to many therapists. They are concerned that therapists will choose biological interventions rather than a more integrated approach
shunt
tube implanted in the body to redirect the flow of a fluid
angioma
tumor composed of blood vessels
If a patient says "My mother is coming to see me today." and the nurse responds "How nice. There's nothing as comforting as a mother's love." The nurse has used a _______ and a ________
value statement (how nice); cliche (there's nothing as comforting as a mother's love)
thromboangiitis obliterans
vascular inflammatory disorder usually affecting the lower extremities (also called Buerger's disease)
The _______ level of communication involves aspects which depend solely on speech
verbal
• Identify barriers to effective coordination of patient care and teamwork.
verbal abuse and disruptive behavior, not having a work relationship with physicians
Congruent Communication
verbal and non verbal communication
• Establish and publish minimum curriculum requirements and standards for individuals seeking licensure • Approve nursing education programs • Establish standards of nursing practice and education • Examine, approve, renew and reinstate licenses • Deny, revoke, suspend, probate, limit or otherwise restrict licenses
what are some of the duties of LSBN?
Promptness, precision, standardized procedures, routines, neatness, organization, objectivity, authority, faith in technology
what are the Health System Cultural values?
Medicare/Medicaid, Labor Laws, ADA
what are the legal standards for justice?
assessment, planning, intervention, evaluation, teaching, supervision
what are the legal standards of the nurse according to the rules and regulations?
Locus of Control
who is responsible? Internal- believe what they do makes a difference External- believe what they do won't make a difference
During the __________ phase of the nurse-patient relationship the nurse and patient address tasks outlines within the previous phase and problems and needs are identified
working
During which phase of the nurse-patient relationship does the nurse work with the patient on changing behaviors
working
Information taken during the assessment stage of the nursing process can be both ____ and ____
written; verbal
Treatments for Sexual Dysfunctions? in past 40 years, major changes
~Early 20th century: Psychodynamic therapy: •Believed that sexual dysfunction was caused by a failure to progress through the stages of psychosexual development •Therapy focused on gaining insight and making broad personality changes; was generally UNHELPFUL ~1950s & 1960s: Behavioral therapy: -Attempted to reduce fear by applying relaxation training & systematic desensitization -Some success, BUT failed to work where key problems included misinformation, negative attitudes, and lack of effective sexual techniques 1970: "sex therapy" program has evolved into a complex approach --> "Human Sexual Inadequacy" Book •Cognitive, behavioral, couples, and family systems therapies, along with a number of sex-specific techniques ~More recently, Biological interventions have also been incorporated
Preventive Care
• Blood pressure and cancer screening • Immunizations • Mental health counseling and crisis prevention • Community legislation (e.g., seat belts, air bags, bike helmets)
objectives of quality improvement programs.
• Continually understand and measure quality of care in terms of structure, or the inputs into the system, such as patients, staff, and environments; process, or the interactions between clinicians and patients; and outcomes, or evidence about changes in patients' health status in relation to patient and community needs • Assess current practices and compare these practices with relevant better practices elsewhere as a means of identifying opportunities for improvement. • Design and test interventions to change the process of care, with the objective of improving quality. • Identifying errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification and human factors training. • Both act as an effective member of an interdisciplinary/interprofessional team and improve the quality of one's own performance through self-assessment and personal change.
• Evaluate nursing actions to protect patient privacy and avoid invasion of privacy
• Don't give out personal information to other people • Autonomy!
AACN's essential elements of BSN education.
• Emphasized patient-centered care • Interprofessional teams • Evidence based practice • Quality improvement • Patient safety • Informatics • Clinical reasoning/critical thinking • Genetics and genomics • Cultural sensitivity • Professionalism
standards of care and why they are important
• Term used to designate what is accepted as "reasonable under the circumstances" and as a "measuring scale" for the "the degree of skill, care, and judgment used by an ordinary prudent RN under similar circumstances." • Based on: State Regulations, State Statutes, National Standards, Academic curricula, Certification criteria, Hospital policies and procedures. • Failure to abide can lead to a malpractice claim accusing the nurse of negligence and making the nurse legally accountable and liable for the damages which occurred.
Under HIPAA:
- Patient can request copy of medical record - Patient must receive notification of privacy rights - Patient must authorize release of information - Institution may use and disclose information for treatment, payment, and health care operations without authorization - Use of data in research requires deidentification, or patient authorization
HIPAA Privacy Rule
- Privacy Rule compliance was enforced April 2003 by the Office of Civil Rights - establishes national standards to protect individual's health information - civil and criminal penalties exist for non-compliance
Two general categories of Sexual Disorders:
- Sexual dysfunctions - problems with sexual responses -Paraphilic disorders- repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations
Effects of Depressants
- Slows the activity of the CNS - Reduces tension & inhibitions - May interfere with judgment, motor activity, & concentration - Death (at very high doses, alcohol can suppress function of brain stem)
deontology
- To do one's duty. Ex: The nurse promptly answers call lights and attends to the patient's needs.
Access to medical records is limited to:
- Treatment - Quality Assurance - Utilization Review - Education - Research
Medical information is to be kept private/confidential with certain exceptions:
- Treatment of minors - HIV + and certain communicable diseases - Abuse of child or adult - criminal cases - government requests - public right to know - transportation safety - duty to report harms/wounds
Confidentiality and Students
- When you are a student in a clinical setting compliance with HIPAA is part of professional practice - You can review your patients' medical records only for information needed to provide safe and effective patient care - You do not access the medical records of other patients on the unit - Access to electronic health records is traceable through user log-in information
Informed Consent
- a person's agreement to allow something to happen based on full disclosure of risks, benefits, alternatives, and consequences of refusal - a legal and bioethical issue - the process of understanding the risks and benefits of treatment - open, direct, honest exchange of information
Privacy
- the right to keep some information to themselves and to have it used only with approval - the right to be free from unreasonable intrusion into one's private affairs - the right to make choices without outside interference - Autonomy, Justice, Human Dignity
Basic learning principles
-Ability to learn: physical/cognitive abilities, developmental level, physical wellness, thought processes
Federal Statutory Issues in Nursing Practice
-American with disabilities Act -Emergency Medical Treatment and Active Labor Act -Mental Health Parity Act -Uniform Anatomical Gift Act -Living wills -Durable power of Attorney -HIPPA -Advance Directives -Restraints
Factors of Effective and Ineffective Groups
-Atmosphere: comfort vs tense -Goal setting: clear goals vs unclear -Leader/member participation: effective leadership is shared at times vs dominating autocratic -Cohesion: high level of trust -Creativity: encouraged, open to new ideas ETC.
Female sexual interest/arousal disorder
-Characterized by a lack of normal interest in sexual activity •Women with this condition rarely initiate sexual activity and may experience little excitement during sexual activity -Reduced sexual interest and desire may be found in as many as 33% of women
Characteristics of an assertive person
-Confident -In control -Professional Image -Good leader -Communication skills
Barriers to Communication
-Confusing messages -Giving advice -Too much self-disclosure -Excessive questioning -WHY questions, AVOID -Changing subject -False reassurance
Internal Influences
-Dependence/Independence -Coping Ability -Hardiness/Learned Resourcefulness -Resilience -Spirtuality
Variables Influencing Health and Health Beliefs and Practices Internal Variables
-Developmental -Intellectual background -Perception of Functioning -Emotional Factors -Spiritual factors
Factors that Influence Group Functioning
-Goals: provide rationale and motivation for people to form a group -Norms: the rules or expectations of behavior -Cohesiveness: sense of wellness, the cement that holds the group together -Leader Behavior: democratic vs autocratic -Member Behavior: motivated vs not involved
Institute for Healthcare Improvement believes new designs can be developed to accomplish three objectives:
-Improve the health of the population -Enhance the patient experience of care -Reduce or control the per capita cost of care
Assertive Behavior
-Increases patient safety -Improves patient -Promotes a positive working environment
EXCITEMENT phase of the sexual response cycle
-Marked by: changes in the pelvic region general physical arousal increases in heart rate muscle tension blood pressure rate of breathing •In men: erection of the penis •In women: swelling of the clitoris and labia and vaginal lubrication •Female sexual interest/arousal disorder may include dysfunction during the excitement phase •In addition, a male disorder - erectile disorder - involves dysfunction in the excitement phase only
Elements of Communication Process
-Senders and Receivers: speaking and listening -Message: verbal and nonverbal, channel -Feedback: response to message, create meaning (clarify) -Context: situation and setting
Sick Role
-behavior that is dependent, passive, submissive -exempt from social responsibilities -cannot be expected to take care of themselves -sick person should want to get well -seek medical care "cooperate"
Peplau
...
Match the correct name of the institution with its description: 1. poorhouses or workhouses A. pesthouses 2. used to controlled disease B. religious & public hospitals 3. established eventually, became norm C. first US hospital: 4. Pennsylvania General Hospital 1751 D. almshouses
1-D, 2-A, 3-B, 4-C
Match Later Period of Nursing Nurse with their achievement: 1. 1858-1956 wanted practicing nurses to pass a written exam and be licensed, developed practice standards 2. 1812-1912 founded American Red Cross, civil war nurse 3. 1858-1948 principal & superintendent of the School of Nursing @ Johns Hopkins Hospital in 1896, advocated for university education for nurses 4. got Army to allow men to join Nurse Corps, advocated for baccalaureate license A. M. Adelaide Nutting B. Clara Barton C. Luther Christman: D. Lavinia Dock
1-D, 2-B,3-A,4-C
Veracity
Adherence to the truth; truthfulness; ANA: Informed consent is more than just a piece of paper a patient signs, they have to know risks, benefits, alternative treatments, even though its not a legal standard it has reimbursement issues also
Jessie Sleet Scales
African American public health nurse
Factors that effect ability to communicate
Age: older people don't talk about feelings Gender: men talk less, woman open to talk about feelings Culture: expectations and how they discuss Experience with illness: fear Family norms: open or closed communication Self-awareness: how do I affect other people Emotional Intelligence
Needlestick safety and prevention act Mandated nurse to nurse staffing ratios Increased scope of Practice
All examples of nursing political actions
The highest rate of substance use disorders in the US is found 15.5% among __ while the lowest is 3.5% among __.
American Indians; Asian Americans
"tease technique"
Ch. 13 Sensate-focus exercise for erectile disorder in which you...
C.A.R.E.
Connect: offering yourself, "what can I do for you" Appreciate: clients situation, don't say "I understand" Respond: to their needs, "What do you need from me?" Empower: the client to problem solve with you
What is informed consent?
Consent must be voluntary Consent must be given by an individual with the capacity and competence to understand The patient must be given enough information to be the decision maker
Phase 5
Evaluation
T/F: Public health nursing moved from clinics to home care, then back to clinics when home health nursing expanded rapidly during the late '70's
False: 80's & 90's
T/F After WWII, technological advances slowed because of the scarcity of resources for research.
False: grew because of great investment in research
Sexual masochism disorder
Fantasies, urges, or behaviors involving the act or the thought of being humiliated, beaten, bound, or otherwise made to suffer (doesn't warrant diagnosis without 3 D's) CAUSES: - Fantasies begin in childhood and develop through behavioral process of classical conditioning
Specific techniques for Premature ejaculation
Has been successfully treated for years by behavioral procedures: -"stop-start" or "pause" procedure -Some use SSRIs (serotonin-enhancing antidepressant drugs) Often reduce sexual arousal or orgasm = may be helpful in delaying premature ejaculation •Many studies have reported positive results with this approach
Physical characteristics (PIIHI)
Height, weight, gender, race, hair color, eye color, presence/amount of facial hair, scars, tattoos.
Is Arkansas's rate of uninsured higher or lower than the national average?
Higher
Who wrote "Interpersonal Relations in Nursing"
Hildegard Peplau
Therapeutic Use to Self is associated with which nurse?
Hildegard Peplau The Orientation Phase Developing trust The Working Phase The Termination Phase
Greeks
Hippocrates (father of western medicine) wrote first medical text
fidelity
Honoring your commitment. Example: A nurse is obligated to continue to provide care for a patient until another nurse can relieve her.
Makes statutory law delegates authority
Legeslative
Formal Socialization
Lessons planned for us. ex: training DIRECT INSTRUCTION FROM OTHERS.
What nurse is associated with public health care nursing?
Lillian Wald
Diagnostic Related Groupings
Medicare uses, prospective payment, sets limits on amount of money paid for services based on patients given DRG (diagnosis of illness)
What % of Americans have used hallucinogens at some point in their lives?
More than 14% - Tolerance and withdrawal are rare; But the drugs do pose dangers: - Another danger is the risk of "flashbacks" - "bad trip" o Can occur days or months later
A nurse is providing patient teaching for a patient undergoing chemotherapy. The nurse is explaining that the chemotherapy will cause some unpleasant side effects, such as nausea and hair loss. In this situation, the nurse is using which ethical principle?
Nonmalfecience
Disorders of Excitement
Normal levels of desire, interest in sex, BUT trouble getting aroused (Excitement phase of sexual response cycle)
Acquired Type
Normal sexual functioning preceded the disorder (can be due to trauma)
The ____________ is the organization which is responsible for classification of nursing diagnosis
North American Nursin Diagnosis Assesiation International (NANDA; NANDA-I)
STTI
Not for profit international organization o Mission- to provide leadership and scholarship in practice, education, and research to improve the health of all people
What did Florence write?
Notes on Nursing-identified unique body of nursing knowledge
_________ are the standardized outcomes for patients which is used to evaluate the effectiveness of nursing interventions
Nursing Outcomes Classifications (NOC)
Improve care of patients with skin breakdown Decrease light and noise Use caps on newborns Postition patients Schedule pain medications ARE ALL EXAMPLES OF
Nursing theory and practice
performance anxiety & spectator role
Once a man begins to have erectile difficulties, he becomes FEARFUL&WORRIES during sexual encounters; instead of being a participant, he becomes a spectator and judge -This can create a vicious cycle of sexual dysfunction where the original cause of the erectile failure
Risk management
One tool used in risk management is the incident report or occurrence report. Occurrence reporting Serves as a database for further investigation Alerts risk management to a potential claim situation.
Minimum disclosure
Only people involved in your health care can have access to your records
Paraphilia
People who initiate sexual contact with children warrant a diagnosis of pedophilic disorder regardless of how troubled the individuals may be or not --> diagnosed when... harm? -2/3 victims are female CAUSES: Sexually assaulted, punished, neglected in past, deprived of relationships
Autonomy
Principle of respect for the person, People are free to form judgments and actions as long as they do not infringe on others
Veracity
Principle of truth-telling
Precedent
Prior decision by a court of law
Voluntary Standard
Professional organizations constantly assess needs of society with respect to health care and develop standards for professional practice; i.e.: Standards for practice serve as guides and are used when evaluating care given or an individual's job performance
Contract
Promise that is enforceable by law
General Standard
Standards for practice and education that apply to all nurses regardless of type of job or specialty; i.e.: Nursing: Scope and Standards of Practice, ANA
Internal Standard
Standards specific to an institution developed by staff based on their expectations; i.e.: job description, policies and procedures manual
External Standard
Standards that are developed by national organization or federal mandates; these are national standards; i.e.: LSBN, ANA standards of practice, ANA code of ethics, JCAHO Hospital Standards, OSHA, etc.
the professional & legal sources of regulation of nursing practice
State Nursing Practice Act and Board of Nursing Rules & Regulations: Define the scope and limitations of professional nursing practice
Privacy
State of being concealed; secret. US department of Health and Human services(HHS) "privacy rule"
capitation
System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan.
Madeleine Leininger
Transcultural Nursing- comparative cultural care values and beliefs, made to provide care measures that are used with individual's cultural beliefs
_____ research takes findings in the lab and applies them to the bedside
Translational research
Specific techniques for Erectile disorders
Treatments for ED focus on reducing a man's performance anxiety and/or increasing his stimulation •May include sensate-focus exercises such as the "tease technique" -Biological approaches have gained great momentum with the development of sildenafil (Viagra) and other erectile dysfunction drugs ... as well as "second-line" treatment
Altruism, Autonomy, Human Dignity, Integrity, Social Justice, Role of a professional education, How personal values affect professional behavior
What are some important values in nursing?
Patient-centered care, teamwork and collaboration, evidenced-based practice, Quality improvement, safety-patient identifiers, Informatics
What are the 6 Competencies of QSEN?
Altruism and self-regulation
What are the characteristics of a profession?
Standard
a criterion used as a test of quality; Minimal requirement for acceptable performance
community
a group or class of persons having a common interest/ identity and live in a specified locality
The uninsured pay ______________ for health care than the insured. a. more b. less c. same d. they don't pay, the government pays for them.
a. more
By being an ___________ is the best way to communicate effectively
active listeeer
Dorothea Dix
advocate for the mentally ill
Advocacy
advocates for dignified and humane care
DIVERSITY
affirming the uniqueness of and differences among persons, ideas, values, and ethnicities
Delirium tremens (the DTs)
alcohol withdrawal syndrome
How are Hospitals Classified? (choose all correct answers) a. ownership b. type of service c. quality of service d. length of stay
all but c.
The following are characteristics of a Magnet Hospital except for: a. gold standard for nursing excellence b. due to APN's, eliminates need for doctors c. promoting quality in a setting that supports professional practice d. Identify excellence in the delivery of nursing services to patients/residents e. disseminating "best practices" into field
b. due to APN's, eliminates need for doctors
The nurse collaborates with other__________________ and _______________ in promoting community, national, and international efforts to meet health needs. a. nurses and techs b. health professionals and the public c. professions and disciplines d. cultures and societies
b. health professionals and the public
Actual or potential health problem and Etiological factor are both elements of what part of the nursing process? . Assessment b. nursing diagnosis c. planning d. Intervention/Implementation e. evaluation
b. nursing diagnosis
A(n) _________________ is a situation involving competing rules or principles that appear to have no satisfactory solution a. crisis b. existential situation c. ethical dilemma d. paradox
c. ethical dilemma
In Nursing Assessment, where are secondary sources from? a. patient b. lab c. family/associates d. doctor
c. family/associates
The life-long learning, continued education, receptive to feedback, journals, conferences . authority b. autonomy c. self-growth d. integrity
c. self-growth
Which of these is NOT part of the change process: a. Nurses are Change Agent b. Utilize networking c. Stay an outside observer d. Incorporate stress reduction strategies during the process e. Be an active listener f. Be prepared for change, become involved in change, and be open to instituting change.
c. stay an outside observer
Which of these is NOT an element of a professional image? a. integrity b. initiative c. style d. attitude e. appearance
c. style
A negligent or intentional civil wrong not arising out of a contract or statute a. lawsuit b. claim c. tort d. violation
c. tort
angina pectoris
chest pain, which may radiate to the left arm and jaw, that occurs when there is an insufficient supply of blood to the heart muscle
hyperesthesia
condition of excessive sensitivity to stimuli
aphasia
condition of loss or impairment of the ability to speak
False imprisonment
confinement of a person against his or her will.
EXCELLENCE
creating and implementing transformative strategies with daring ingenuity
atrioventricular defect
defect pertaining to an atrium and ventricle
hematocytopenia
deficiency of blood cells
coronary ischemia
deficient supply of blood to the heart's blood vessels
Administration of medication is an example of which type of nursing intervention?
dependent
________ interventions are activities that are carried out on the order, instruction, or supervision of another health professional with prescriptive authority.
dependent
sex drive
desire! is determined by a combination of biological, psychological, and sociocultural factors •Most cases of low sexual desire are caused primarily by: sociocultural & psychological factors, But biological conditions can also lower sex drive significantly
Miller's Wheel of Professionalism
essential core is that all nursing education be in a 4 yr. school
Wald
established Public Health Nursing
Hill Burton Act
established federal funds to build more hospitals, at one point too many hospital beds- believe to cause shortage of nurses
Negligence
failure to exercise the degree of care that is reasonable nurse would exercise under the same or similar circumstances, nurse fails to delegate properly 4 Elements (duty, breach of duty, cause, harm)
Justice
fairness, all patients deserve same care
aortic stenosis
narrowing of the aorta
Christianity in Middle Ages
o Wealthy women helped peasants o Deaconesses gave care in homes o Catholic convents founded religious orders o Reformation - convents closed
neuralgia
pain in a nerve
cardiodynia
pain in the heart
-Resilience
pattern of successful adaptation, ability to adapt to stress
_________ refers to a set of beliefs about the nature of how things work and how the world should be viewd
philosophy
In _________ the nurse and client establish goals
planning
In the _______ stage of the nursing process, patient goals are identified and designed in order to obtain them
planning
The third step of the nursing process is _____
planning
litigation
the action of a lawsuit
hematoma
tumor of the blood swelling causing an accumulation of clotted blood in the tissues
family
two or more persons who are emotionally involved with each other who may or may not live by each other
Failure to see the _____________ of each individual is a common cause of communication breakdown caused by preconceived ideas, prejudices and stereotypes
uniqueness
Not for Profit
use profits to pay for personal and improve services
Romans
used slaves for nursing care
Implementation normally includes _________ of the care plan
validating
___________ indicate that the nurse has made a judgement, either positive or negative.
value statements
Empathy
way of communication and understanding, putting yourself in their situation, "it would be difficult to lose your mom"
the ANA 6 essential features of professional nursing.
• Caring relationship • Attention to the range of human experiences and responses • Integration of assessment data with knowledge • Application of scientific knowledge and use of judgment • Advancement of the profession through scholarly inquiry • Influence on social and public policy to promote social justice • Assurance of safe, quality, and evidence based practice
• Describe the status of safety in health care today.
•The healthcare system is fragmented and in need of improvement
Dependence/Independence
-helpless attitude -everything for them self, being in charge of their health
Perception
-how we interpret it, process of being aware of and understanding the world
Coping Ability
-how well they cope with their illness/situation -positive or negative experiences
Passive Behavior
-gives in -says yes when really don't want to -rarely express needs and feelings -soft voice/whiny -feel being used -avoid conflict
Aggressive Behavior
-dominating and loud -violate the lights of others -intrusive body language: in your face -insensitive to others needs -frequently confrontive -uses threats "silence"
Symptoms of Cocaine?
- Euphoric rush - mania - paranoia - impaired judgment - cocaine-induced psychosis/hallucinations - Crashing can follow - Risk of cardiac arrest
Eating Disorders Take Home Points:
- Western culture equates thinness with beauty - Rise in eating disorders - Two main disorders: Anorexia Nervosa and Bulimia Nervosa; third disorder: Binge eating disorder
Lillian Wald
-founded Henry Street Settlement -1st public health nursing -visiting nurse
Chronic Illness
-more common -gradual onset -mild to vague symptoms -permanent "HTN, Diabetes"
Passive-Aggressive Behavior
-most difficult to work with -indirect aggression -sarcasm -sabatoging -manipulation
What percentage of all high school seniors have used an illegal drug within the past month?
24%
HAC
10 categories of hospital acquired conditions that will not be reimbursed
Stem cell
A cell from which other types of cells can develop
What is the 7-step Patient Value Clarification Process.
A process for a nurse to use when patients' value system is detrimental to their health
Integrity
Acting in accordance with an appropriate code of ethics and accepted standards of practice
Negligence
An act of omission or commission
Family- What should you know about them?
Are they functional? Who makes decisions? Religion? Involvement? Beliefs about illness and pain?
Phase 1 nursing process
Assessment
Who wrote "Nursing: Concepts of Practice"
Dorthea Orem
4d's of liability
Duty, derelict, direct cause, damage
Generalized type
Dysfunction is present during all sexual situations
The ________ part of the diagnostic statement is the portion which explains the cause or casual factor
E (etology)
...a duty to act
For the professional nurse, action is not based on personal preference, but there is...
At age 30, Florence began nurses training where?
Germany
*Orientation to individual survival *Focus on goodness with recognition of self-sacrifice *Morality of caring and being responsible for others, as well as self
Gilligan's Stages of Moral Reasoning
pleasure or absence of pain
How does teleology define happiness?
pain or the absence of pleasure
How does teleology define unhappiness?
Written notice
How medical info will be used
Teaching considerations
Illiteracy and other disabilities Cultural diversity Using different teaching tools Special needs of children and older adults
Sigma Theta Tau
Invitation only
Who's model focuses on the individual as a biopsychosocial adaptive system?
Roy
Who was the father of the scientific method?
Sir Francis Bacon
definition of risk management
The identification, investigation, analysis and evaluation of risks and the selection of the most advantageous method of correcting, reducing or eliminating identifiable risks
What impacts did WWII have on nursing?
The need for nurses was brought about Cadet Nurse Corp was established
Caregiver
The nurse addresses the client's holistic health care needs to promote health and the healing process. o In the role, the nurse administers treatment for specific disease processes and applies measures to restore the emotional and social well-being of the client.
Autonomy
The patient possesses the capacity to make decisions- values and goals, communicate and understand the information, reason and deliberate about one's choice
Define external locus.
The thought process of believing that you cant prevent things from happening. "If it happens, it happens."
Values
something of worth; an enduring belief or attitude held dearly by a person about people, objects, ideas, or action
Phase 4 i
Implementation
Nonmaleficence
Implies a duty: Not to inflict harm, To abstain from injuring others, To help others further their own well-being by removing harm
Beliefs
Interpretations or conclusions that one accepts as true
Statutory Law
Law enacted codified by the legislation branch of either Federal or State governments
Legislation
Laws
Under which model do nurses modify the environment to facilitate patient adaptation?
Roy
Lois Capps
School nurse, medicare reform elected to US house
the practice of professional nursing as defined in the Florida Nurse Practice Act.
"Practice of professional nursing" means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others.
ANA definition of nursing
"The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations".
Battery
"give patient IV or vaccine, even though they don't want it"
Stages of Illness
1. Disbelief/Denial 2. Irritability and Anger 3. Attempt to Gain Control 4. Depression and Despair 5. Acceptance Participation
Assertive Statements: 3 Parts
1. Your perspective of the situation 2. Your feelings about the situation 3. And your needs regarding the situation
Reflection is used a lot in the profession of nursing when ________ to UAP occurs
delegation
Orlando's theory emphasizes __________ based on observations, which lead to inferences
deliberate action
Choosing
freely, among alternatives, considering consequences
Rosenstock
1. am I vulnerable or susceptible to this disease? 2. how effective is the change? (health behavior) 3. triggering events that change health behavior
Types of Sexual Dysfunctions:
- "lifelong type" - struggle with sexual dysfunction their whole lives or others, - "acquired type" - normal sexual functioning preceded the disorder - "generalized type" - dysfunction is present during ALL sexual situations -"situational type" - tied to particular situations
Prevalence of Anorexia:
- 90-95 % of cases occurs in females - Onset age: 14-18 (time of body change) .5-3.5 % (western culture) 2-6% die (medical or suicide) * Of all psychiatric disorders, mortality rate is the highest for anorexia
American Nurses Association's Code of Ethics for Nurses
*1893 Nightingale Pledge became first ethical code *1926 code of ethics was published in the American Journal of Nursing *1950 with 17 provisions, a 1940 version of a code of ethics was adopted *2001 a complete revision was done on the code of ethics was adopted
Assertive Strategies Continued
*Explanations are not always necessary *State your expectations *Be persistent: Broken Record (repeating yourself) *Momentary Delay (ask for a minute to think) *Take a time out for conflicts *Keep to the issue: focus on client *Try to get to the main point quickly *Give and receive praise and constructive criticism
Ethical theories: Virtue Ethics
*Fundamental belief that the moral rightness of an action is determined solely by its consequence *David Hume, Jeremy Bentham, and John Stuart Mill (1700-1800) *The greatest good for the greatest number of people
Autonomous decisions are based on:
*Individuals' values *Adequate information *Freedom from coercion *Reason and deliberation
Strategies for Political Involvement
*Keep informed of issues affecting nurses and public *Join Professional organizations, SEIU committees/actions *Find a Mentor, be a mentor *Participate in public demonstrations *Participate in shared governance councils, *Meet with elected officials in their offices *Write a letter to elected officials *Publish
Environment
*Most important for patient wellness Circumstances and influences that surround and affect an individual
Ethical theories: Deontology
*Obligation or duty *Immanuel Kant 1724-1804 - an act was moral if its motives or intentions were good regardless of the outcome *Act Deontologist - Gather all of the facts before they act *Rule Deontologist - Always follow on specific rule
Assertive Strategies
*Use "I messages" *Don't be afraid to say no (w/o saying sorry) *Check your non-verbals *Use paraphrasing and clarification *Listen before talking *Don't fear rejection *Accept compliments *Report unacceptable behavior (key to patient safety)
Garnering Support
*Utilize the Media *Know your Friends and Foes *Target Politicians
Kanter (1977) identified three factors that are limiting the influence of women in decision-making and influencing policy
*blocked opportunities for advancement *limited power to mobilize resources *tokenism
Treatments for Paraphilia
- Antiandrogens - drug that lowers the production of testosterone - SSRIs, the serotonin-enhancing antidepressant medications - hopefully to reduce the compulsion-like sexual behaviors •These drugs also have a common side effect of lowered sexual arousa
Maintaining Privacy
- Bedside - Curtained Area - Nurses Station - Fax Machines - Computer Screens
Causes of Female Orgasmic Disorder
- Biological causes •A variety of physiological conditions can affect a woman's arousal and orgasm -These conditions include diabetes and multiple sclerosis •The same medications and illegal substances that affect erection in men can affect arousal and orgasm in women •Postmenopausal changes may also be responsible - Psychological causes •The psychological causes of female sexual interest/arousal disorder, including depression, may also lead to female arousal and orgasmic disorders •Memories of childhood trauma and relationship distress may also be related - Sociocultural causes •For years, the leading sociocultural theory of female orgasmic problems was that it resulted from sexually restrictive cultural messages •This theory has been challenged because: -Sexually restrictive histories are equally common in women with and without disorders -Cultural messages about female sexuality have been changing while the rate of female sexual dysfunction stays constant •Researchers suggest that unusually stressful events, traumas, or relationships may produce the fears, memories, and attitudes that characterize these dysfunctions •Research has also linked orgasmic behavior to certain qualities in a woman's intimate relationships (such as emotional intimacy)
Confidentiality
- Duty owed the patient to protect information shared (autonomy and fidelity) - Health care providers and agencies have responsibility to uphold confidentiality, to provide privacy for patients, and to protect the information collected - only certain individuals have the right to access information
BULIMIA NERVOSA
- Symptoms may last several years with periodic let-up - Unlike anorexics who are forced treatment per usual, bulimics tend to feel emotional and bad about their behavior - they seek treatment - MOST effective treatment: re-empowering the family to direct nutritional needs
LSD, what does it do and what NT?
- Within two hours of being swallowed, it brings on a state of hallucinogen intoxication - Increased and altered sensory perception (Hallucinations may occur) - LSD produced these symptoms by binding to serotonin receptors -These neurons help control visual information and emotions thereby causing the various effects of the drug on the user
Boundary Violations
- can result when there is confusion between the needs of the nurse and those of the patient - Professional Sexual Misconduct is extreme form of boundary violation
When is a patient incapable of making informed consent?
- incapacitated, incompetent - premedicated - known mental illness/handicap - organic brain disease/dementia - minor in age - health literacy and linguistic barriers Implied Consent - emergency situation (trauma)
Breach of Confidentiality
- information may be disclosed when failure to do so could cause serious harm to patient, family, facility staff, or others - law requires disclosure in some situations - case law requires duty to disclose a patient's threat of imminent physical harm against another identifiable person
What are the three ways in which you can collect data during the assessment stage of the nursing process?
- interviewing - Physical Examination - Consultation
Brown Report
- recommended that nursing education programs be housed in universities- formed basis for evaluating nursing programs
Professional Boundaries
- the spaces between the nurse's power and the patient's vulnerability
Alcohol
-Absorbed into the blood via stomach lining taking effect in bloodstream and CNS -First area affected: controls judgment -The extent of the effect of ethyl alcohol is determined by its concentration (proportion) in the blood
Grief
-An emotional response to a loss, manifested in ways unique to an individual based on personal experiences, cultural expectations, and spiritual beliefs. Normal (uncomplicated) Complicated: exaggerated, delayed, masked Anticipatory Disenfranchised (aka marginal or unsupported)
Irritability and Anger
-Anger directed toward body or person
Modern sex therapy focuses on:
-Assessment & conceptualization of the problem -Mutual responsibility -Education about sexuality -Emotion identification -Attitude change -Elimination of performance anxiety and the spectator role -Increasing sexual and general communication skills -Changing destructive lifestyles and marital interactions -Addressing physical and medical factors
Florence Nightingale
-Born in 1820, aristocratic family -Went with mother to homes of sick to provide care -Age 30, began nurse's training in Germany -Tended wounded British soldiers at Scutari Hospitals in Turkey during Crimean War -Reformed British Army Hospitals -Established 1st training school for nurses in London -Wrote " Nurse on Nursing"- identified unique body of nursing knowlege
Domains of learning
-Cognitive: includes all intellectual behavior and requires thinking -Affective: deals with expression of feelings and acceptances of attitudes opinions or values -Psychomotor: involves acquiring skills that require integration of mental and muscular activities
DESIRE phase of sexual response cycle
-Consists of an interest in or urge to have sex, sexual fantasies, and sexual attraction to others sex drive •Two dysfunctions affect this phase: Male hypoactive sexual desire disorder and Female sexual interest/arousal disorder
Responding to Criticism
-Criticism is viewed as rejection -Can be painful -Dealing with criticism: silence, avoidance, get evens
• Identify the types of adverse events which must be reported to the Florida Agency for Healthcare Administration & the time frame for doing so
-Death of a patient * -Brain or spinal damage * -Performance of surgical procedure on the wrong patient * -Performance of a wrong-site surgical procedure * -Performance of surgical procedure that is medically unnecessary or unrelated to patient's diagnosis or medical condition * -Surgical repair of damage resulting from a planned surgical procedure, where damage is not a recognized specific risk -Performance of procedures to remove unplanned foreign objects remaining from a surgical procedure
Disbelief/Denial
-Difficult in believing -Fear of Illness -Believe symptoms go away
• Identify where medical errors are likely to occur. (Treatment)
-Error in the performance of an operation, procedure, or test -Error in administering the treatment -Error in the dose or method of using a drug -Avoidable delay in treatment or in responding to an abnormal test -Inappropriate (not indicated) care or test
• Identify where medical errors are likely to occur (Diagnostic)
-Error or delay in diagnosis -Failure to employ indicated tests -Use of outmoded tests or therapy -Failure to act on results of monitoring or testing
• Identify where medical errors are likely to occur. (Preventive)
-Failure to provide prophylactic treatment -Adequate monitoring or follow-up treatment
Variables Influencing Health and Health Beliefs and Practices External Variables
-Family Practices -Socioeconomic factors -Cultural background
Benefits of Studying Communication
-Good communication abilities with physical, emotional, and psychological well being (poor communication = poor job performance, social isolation) -Means ability to process health information and make quality decisions -Communication affects self concept and way others see us -Communication skills are most valuable skills you can possess
Disorders of Desire: Female sexual interest/arousal disorder (33%)
-Lack of normal interest in sexual activity -Rarely initiate sexual activity & may experience little excitement during sexual activity
State Statutory Issues in Nursing Practice
-Licensure -Good Samaritan Laws -Public health laws -The Uniform Determination of Death Act -Physician-Assisted suicide
Anorexia symptoms & problems:
-May display Psychological problems: depression anxiety low self-esteem substance abuse insomnia/sleep disturbances Obsessive-compulsive patterns -Medical Symptoms from Starvation: amenorrhea low body and blood temperature body swelling reduced bone density slow heart rate metabolic/electrolyte imbalance poor circulation lanugo (hair on body) dry skin and nails
Basic learning principles
-Motivation to learn: pt's desire/willingness to learn
Nonverbal skills/attending skill
-Not what you say, but how you say it -More than just your facial expressions
Culture
-Pattern of learned behavior and values that are reinforced through social interactions 1. Communication (verbal vs nonverbal) 2. Personal Space 3. Values 4. Role Expectations 5. ETHNOCENTRISM (your culture is superior to everyone else's
How to develop self-awareness
-Pay attention to the effect you have on people -Listen to feedback -Be open to new experiences -Be non-judgmental -Be the mentalist: all behavior has meaning
Erectile Disorder (ED) of excitement phase (10% of males)
-Persistent inability to attain or maintain an erection during sexual activity
Risk Factor Modification and Changing Health Behaviors
-Precontemplation Not intending to make changes within the next 6 months -Contemplation Considering a change within the next 6 months -Preparation Making small changes in preparation for a change in the next month Improvement in health may involve a change in health behaviors. -Action Actively engaged in strategies to change behavior; lasts up to 6 months -Maintenance stage Sustained change over time; begins 6 months after action has started and continues indefinitely
Levels of Prevention
-Primary:True prevention that lowers the chances that a disease will develop -Secondary:Focuses on those who have a disease or are at risk to develop a disease -Tertiary Occurs when a defect or disability is permanent or irreversible
Causes of Premature Ejaculation
-Psychological, particularly Behavioral explanations: (most supported) •The dysfunction seems to be typical of young, sexually inexperienced men •It may also be related to anxiety, hurried masturbation experiences, or poor recognition of arousal -Growing belief with biological factors: •One Theory: Some men are born with a genetic predisposition •2nd Theory: Brains of men with early ejaculation contain certain serotonin receptors that are OVERactive &others that are UNDERactive •3rd Theory: these men experience greater sensitivity or nerve conduction in the area of their penis
Nursing Process: Assessment (teaching)
-See through the patient's eyes. -Teaching is patient-centered. -Assess the patient's learning needs. -Ask questions to identify motivation to learn. -Determine the patient's physical and cognitive ability to learn. -Provide an appropriate teaching environment. -Assess the readiness and ability of a family caregiver or other learning resource. -Assess health literacy/learning disabilities.
Specific techniques for Sexual Pain or Genito-Pelvic Pain/Penetration Disorder
-Specific treatment for involuntary contractions of the vaginal muscles: 1. Practice tightening and releasing the muscles of the vagina to gain more voluntary control 2. Overcome fear of penetration through gradual behavioral exposure treatment -Works for most women! •Mostly Physical Causes = Pain management techniques & medical intervention may be necessary
Effects of Stimulants
-Substances that increase the activity of the CNS -Cause increases in blood pressure, heart rate, and alertness -Cause rapid behavior and thinking
Nurse role in teaching
-Teach information that the pt and the family need to make informed decisions regarding their care. -Determine what pt need to know -Identify when pt are ready to learn
Six areas of Potential Communication Breakdown
-The nurse patient relationship, lack of trust, -Exchange of necessary information with pt -Ensure accuracy in delivering correct treatment -Exchange of necessary information w/ health care professionals -Accurate interpretation of data (preception, feedback)
• Describe health care organization accreditation and the role of the Joint Commission
-The process by which organizations are evaluated on their quality, based on established minimum standards The Joint Commission -Accredits HCO -focus: Continuous QI -Survey visits q 3 years -Standards (med management, safety goals, record of care)
Implentation of communication
-Therapeutic communication techniques are specific responses that encourage the expression of feelings and ideas and convey acceptance and respect. -Active listening means being attentive to what a patient is saying both verbally and nonverbally. Use "SOLER": Sit facing the patient; observe an open posture, lean toward the patient, establish and maintain intermittent eye contact; relax
Trends: Sex therapists have moved well beyond the approach first developed by Masters and Johnson
-Therapists now treat unmarried couples, those with other psychological disorders, couples with severe marital discord, the elderly, the medically ill, the physically handicapped, gay clients, and clients with no long-term sex partner
Specific techniques for Desire disorders
-These disorders are among the MOST difficult to treat because of the many issues that feed into them -Therapists typically apply a combination of techniques, which may include: Affectual awareness Self-instruction training Behavioral techniques Insight-oriented exercises Biological interventions - hormone treatments
Civil and Common Law Issues in Nursing Practice
-Torts -Intentional -Assault -Battery -False imprisonment -Quasi-intentional Invasion of privacy Malice Slander Libel -Unintentional Negligence Malpractice
Effects of Cannabis
-When smoked, cannabis produces a mixture of hallucinogenic, depressant, and stimulant effects - At low doses, the user feels joy and relaxation - May become anxious, suspicious or irritated --> Cannabis use disorder
Hardiness/ Learned Resourcefulness
-ability to resist stressful life events -acquiring skills that enable effective coping
Acceptance Participation
-acknowledged the reality of illness and ready to participate in decisions
Nurse Politician
-actually running for office -seek appointment with gov. agency -member on Board of Nursing
Purpose of Professional Organizations
-allow members to work together towards a common goal -ensure competence and learning among members -influence policy members -provide educational opportunities
The Counselor Role
-based on feelings on fact, gather actual data, important "pain level" -based on trust and caring, treat with dignity -Goal is to 1. Recognize and identify and label their feelings, 2. Accept what they feel, okay to be angry, happy 3. Express -Can't fix problem for the patient, avoid: fix-it syndrome -Help client fix own problem: learn new skills to problem solve -Provide the opportunity to open up (AVOID- "should, do")
Environment
-circumstances and influences that affect the individual -Family: supportive, functional, learn to assess family -Cultural systems: attitude, behaviors, ethnic groups, what could influence health -Social Systems: neighborhood health, level of poverty, access to healthcare -Community systems: larger environment that influences health, ex: epidemic, job market, weather
Cultural Competence
-consider cultural differences when planning care for their patients -interpret behaviors accurately -respect
Attempt to Gain Control
-consult health care provider, use OTC -aware they are ill -treatment seeking
Main components of assertiveness
-directing people to do things -straight forward/fair -sensitive and responsive to other people
3 trends affecting health care
-increase number of older Americans, more diversity -increase use of technology -economic globalization
WWI
-national campaign to recruit nurses, Army School of Nursing -initiated public health education and home nursing through Red Cross
List need to Prove negligence
-nurse Owed a duty to the patient. -The nurse did not carry out the duty or breached it. -The patient was injured. -The patient's injury was caused by the nurse's failure to carry out that duty.
Vietnam War
-nurses worked without direct MD supervision -performed emergency procedures on their own
Integrating the Nursing and Teaching Processes
-nursing process and teaching process are not the same. -The nursing process focuses on the patient's total health care needs. -The teaching process focuses on the patient's learning needs and ability to learn. -When education becomes part of the care plan, the teaching process begins.
Nurse Activists
-politically active in nursing organizations -work for a campaign -contribute money
Cultural Influences on Illness
-powerful effect on behaviors -personal experience -may feel sick even if no disease present -disease without loss of function
Assertiveness Facts
-promotes mutual understanding -respect of all parties is fostered -communication is fair -facilitates effective problem solving and conflict management -standing up for your rights without violating rights of others
Functions of Organizations
-regulate nursing practice -identify standards of practice (code of ethics) -develop knowledge -communicate with public -support their members thru networking -provides mentoring
Acute Illness
-short lived -resolved on own -no permanent damage "common cold"
Power
-the ability to make something happen -without power there is "no influence"
Person/Individual
-the person we are caring for, freedom of choice, need to think each is unique, values affect decision-making -Human Needs Theory: Maslow's Theory- review basic needs, must be met first -Adaptation: persons ability to grow and change, very individualized, resilience is ability to adapt -Homeostasis: balance, intrastability
Nurse Citizen
-voting, being informed, speaking out
Learning environment
-well lit -appropriate funiture -quiet -good ventilation -comfortable temperature -private (group or individual)
Depression and Despair
-work/daily activities altered -depression based on severity of illness
Nurse patient relationship
. Preinteraction phase: occurs before meeting the patient 2. Orientation phase: when the nurse and the patient meet and get to know each other 3. Working phase: when the nurse and the patient work together to solve problems and accomplish goals 4. Termination phase: occurs at the end of a relationship
Components of Critical Thinking in Nursing
. Specific knowledge base in nursing II. Experience III. Critical thinking competencies IV. Attitudes for critical thinking V. Standards for critical thinking A. Intellectual standards B. Professional standards
Describe terms related to Ethics and give examples in nursing practice: Beneficence, nonmaleficence, autonomy, fidelity, justice, value, and accountability.
...
Johnson
...
King
...
Levine
...
Neuman
...
Orlando
...
nursing scope of practice
1 Assessment: The registered nurse collects comprehensive data pertinent to the patient's health and/or the situation. 2 Diagnosis: The registered nurse analyzes the assessment data to determine the diagnoses or issues. 3 Outcomes Identification: The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation. 4 Planning: The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. 5 Implementation: The registered nurse implements the identified plan. 5a Coordination of Care: The registered nurse coordinates care delivery. 5b Health Teaching and Health Promotion: The registered nurse uses strategies to promote health and a safe environment. 5c Consultation: The graduate level-prepared specialty nurse or advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change. 5d Prescriptive authority and treatment: The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatment, and therapies in accordance with state and federal laws and regulations. 6 Evaluation: The registered nurse evaluates progress toward attainment of outcomes.
Name the steps of the research process
1) Identify a research Problem 2) Review literature 3) Formulate a hypothesis 4) Design of the study 5) Implement a study 6) Draw conclusions based on finding 7) Discuss clinical implication 8) Pass out findings
Stages of political development
1- buy in 2-Self interest 3-political sophistication 4-leading the way
Relationship to other disciplines matching: 1. background on human condition, virtues, learn about mistakes/successes, languages 2. morality, religion 3. medicine, pathophysiology 4. assessments, non-verbal communication 5. help understand groups & people A. literature, arts, philosophy/ethics B. communications C. humanities: D. life sciences: biology, A&P, microbilogy, chemistry E. Social Sciences: sociology, anthropology, psychology
1-C, 2-A, 3-D, 4-B, 5-E
Match the Credential Acronym with the description of what they do. A. CEN B. CRNA C. GNP D. ANCC E. CNM 1. work with population >65 yoa 2. works with childbirth, using more traditional techniques 3. Body that credentials nurses 4. Works in Emergency Departments 5. Administers anesthesia during surgeries, childbirth, etc...
1-C, 2-E, 3-D, 4-A, 5-B
Match the type of ownership with the definition/name 1. public 2. federal 3. state 4. for profit 5. non-profit A. Armed Service Hospital, VA B. reinvest profits back into institution, takes care of indigent C. health department D. mental health center, UAMS E. returns dividend to investors
1-C,2-A,3-D,4-E,5-B
Match the name with the date/description/effect of the Major policies/acts regarding health care: 1. Act for relief of sick and disabled seamen 2. Morril Act 3. Federal Food and Drug Act 4. Food and Drug Cosmetic Act a. Land Grant College: research b. 18th c. c. more regulations, founded FDA d. regulate food processing & drug formulation
1-b, 2-a, 3-d, 4-c
Match the name with the date/description/effect of the Major policies/acts regarding health care: 1. the Social Security Act 2. National Institutes of Health 3. Hill-Burton Act 4. Patient Self-Determination Act 5. Office of Public Emergency Preparedness a. 27 institutes, grant research $$ to improve health, $$ for fellowships for doctoral students b. natural disaster prep. c. advanced directives d. seniors, mothers & dependent children e. federal $$ for building community hospitals.
1-d, 2-a, 3-e,4-c,5-b
Societal changes that will impact nursing:
1. Aging population 2. Poverty 3. Cultural diversity 4. Urbanization 5. Disasters and Bioterrorism 6. Obesity 7. Tobacco use 8. Lack of Exercise 9. Stress 10.HIV/AIDS 11.Substance abuse 12.Violence
Nursing Process- 5 Phase
1. Assessment 2. Analysis and Diagnosis 3. Planning 4. Implementation 5. Evaluation
Human Needs Theory- Maslow's Theory
1. Basic physiologic needs: air, food, shelter 2. Safety needs: physical safety and psychological security 3. Love and Belonging needs: intimacy and relationships 4. Esteem needs: self-esteem, self-respect, self-reliance 5. Self-Actualization: attaining maximum potential
Regulations Set by a State Nursing Practice Act
1. Defines the practice of professional nursing 2. Sets the minimum educational qualifications and other requirements for licensure. 3. Determines the legal titles and abbreviations nurses may use. 4. Provides for disciplinary action of licensees for certain causes.
human sexual response described as a cycle:
1. Desire 2. Excitement 3. Orgasm 4. Resolution *In dysfunction, 1st three phases affected.
What are the 3 key concepts of health?
1. Dynamic and always changing 2. Holistic (incorporating all of the systems) 3. The definition of health is influenced by the beliefs, attitudes, values and perceptions of the patient
Time management
1. Goal setting( Assessment): Review the patient's goals of care for the day and any goals you have for activities such as completing documentation, attending a patient care conference, giving a staff report, or preparing medications for administration.
What are the three Rosenstock health behavior statements?
1. How serious is it? 2. How effective is the healthy behavior? 3. Triggering event
Research Process for Evidence Based Practice
1. Identification of Problem 2. Review Literature 3. Research Question/Hypothesis 4. Study Design 5. Implementation 6. Conclusions 7. Discussion 8. Dissemination of Findings
Health Promotion, Wellness, and Illness Prevention
1. Immunization programs 2. Routine exercise good exercise 3. Physical awareness, stress management self responsibility
What are the two Healthy People goals?
1. Increase the quality and number of years of healthy life. 2. Decrease health disparities (even out the playing field)
Effect the aging population will have on nursing and the healthcare system?
1. Increased need for caregivers and health providers 2. Increased medical costs 3. Increased care moving from the hospital to the community 4. End of life and palliative care issues.
What is Pender's Health Promotion Model?
1. Individual characteristics: prior related behaviors, personal factors. ex: habits, age, sex, education, young are more likely to change. 2. Behavior specific thoughts: perceived benefits, barriers, self-efficacy. ex: time, money, pain, what's the payoff? 3. Behavioral outcomes: level of commitment, competing demands. ex: time, money, motivation, family, school, jobs
Types of sexual dysfunction? (4)
1. Lifelong type - Struggle with sexual dysfunction their whole lives 2. Acquired Type - Normal sexual functioning preceded the disorder (can be due to trauma) 3. Generalized type - Dysfunction is present during all sexual situations 4. Situation Type - Situation specific
the 7-step Patient Value Clarification Process.
1. List alternatives 2. Examine possible consequences of choices 3. Choose freely 4. Feel good about the choice 5. Affirm the choice 6. Act on the choice 7. Act with a pattern
Stages of Group Development
1. Orientation or Forming 2. Dissatisfaction or Storming 3. Resolution or Norming 4. Production or Performing 5. Termination Stage or Adjourning
How can nurse protect him/herself?
1. Practice in safe setting 2. Communication 3. Thorough documentation
5 Rights of Safe Delegation
1. Right task 2. Right circumstances 3. Right person 4. Right direction 5. Right supervision/evaluation.
List the conditions that must be necessary to prove malpractice.
1. The nurse has specialized knowledge and skills and through the practice of that specialized knowledge the nurse causes injury. 2. The nurse had assumed duty for the patient's care. 3. The nurse breached that duty by failing to meet the standard of care. 4. The failure of the standard of care was related to the cause of the injury. 5. The injury is proved.
What are the three characteristics of Human Values?
1. Values change as we mature 2. All humans have the same BASIC values 3. Values are developed in response to our culture and experience
What percentage of adults used illegal substances in past month?
10%
Only __% receive treatment for substance abuse disorder from a mental health professional (some go themselves, some go for legal sentencing, forced to go, etc.)
11%
Spanish American War
1898, set stage for Army Nurse Corporation
Allowed Nurse Practitioners and Clinical Specialists to bill Medicare for nursing services directly Changes are not often implemented Nurse Practitioners may not get fairly reimbursed for their services
1997 Balanced budget act
Mary Eliza Mahoney
1st African American professionally educated nurse
Masters
2 year program after receiving BSN
Excitement
2. Marked by: -Changes in the pelvic region -General physical arousal -Increases in hear rate -Muscle tension -Blood pressure -Rate of breathing In men: erection of the penis In women: swelling of the clitoris, labia, and vaginal lubrication
Time management
2.Time analysis: Reflect on how you use your time. While working on a clinical area, keep track of how you use your time in different activities. This provides valuable information to reveal how well organized you really are.
What percentage of elderly patients are re-admitted within 30 days?
20%
When did the international council of nurses adopt the code of ethics for nurses?
2005
Nursing Theory Patient Care Approach -Faye Abdellah
21 Nursing Problems -promotes problem solving approach to practice Physiological needs-Safety needs and love needs-Esteem needs-
How many people in US have used an illegal substance in the past month?
22 million
__% of all people in the US, over the age of 11, most of them male, binge-drink each month
24 percent
Nurse Licensure compact
24 states Nurses may have licensure in one state and legally practice in another If a nurse moves to another state licensure is only good for 30 days
How many levels does Kohlberg's Stages of Moral Reasoning have?
3
Time management
3.Priority setting: Set the priorities that you have established for patients within set time frames. For example, determine when is the best time to have teaching sessions, plan ambulation, and provide rest periods based on what you know about the patient's condition. For example, if a patient is nauseated or in pain, it is not a good time for a teaching session. Interruption control: Everyone needs time to socialize or discuss issues with colleagues. However, do not let this interrupt important patient care activities such as medication administration. Use time during report, mealtime, or team meetings to the best of your advantage. In addition, plan time to assist fellow colleagues so it complements your patient care schedule.
Nurses spend approx how much of their time dealing with patient care?
30%
Which of the following is not a valid pathway to nursing: a. hospital based diploma program b. 4 years work as a can, take NCLEX & work as LPN b. 2yr associates degree c. 4 year baccalaureate degree d. Non-nursing degree → Masters nursing program
4 years work as a can, take NCLEX & work as LPN
Time management
4. Evaluation: At the end of each day take time to think and reflect about how effectively you used your time. If you are having difficulties, discuss them with an instructor or a more experienced staff member.
Defamation of characters
A legal charge for disclosing unauthorized information that could harm the reputation of another
False imprisonment
A legal claim patients can charge if they are held against their will, unless they are mentally incompetent or a danger to themselves or others
Designation of health care surrogate
A legally recognized document in which individuals designate specific people to act on their behalf if they become unable to make health care decisions for themselves
Student Nurse
A person who is engaged in learning experiences in a program of study leading to candidacy for licensure to practice as a RN; Work as unlicensed Personnel
cultural humility
A respectful partnership with each patient through: • Patient focused interviewing • Exploring similarities and differences between own and patients priorities, goals
Health Promotion
A role of the professional nurse Finding ways to help individuals develop a state of physical. spiritual, and mental well being. Activities encourage optimal functioning. Finding ways to help patients be healthy. "preventing illness"
Established rules of conduct to be used in situations where a decision about rights and wrongs must be made A. Morals B. Values C. Ethics D. Bioethics
A-Morals
A PICO questions consists of what four sections A. Population, intervention, comparison, outcome B. Population, individuals, competency, outcome C. People, ideas, consideration, overview D. Patients, intervention, consideration, objective
A-Population
Fraud
False representation of fact.
Benner's 5 Stages of Nursing Proficiency
novice, advanced beginner, competent, proficient, expert
In 1973 ______ published standards describing the nursing process steps
ANA
A nurse is considering a leadership position and is discussing plans with the nurse manager, who agrees to mentor the nurse. The nurse manager will likely work with the nurse as the nurse develops which leadership attribute?
Ability to accept responsibility
cultural competence
Acquisition of the values, knowledge, skills and attributes that will allow an individual to work appropriately in cross cultural situations
Pharmacology Responsibilities
Administer drugs, evaluate therapeutic responses to drugs, promote client adherence, providing education, intervene for adverse effects
A nurse is caring for a patient who states, "I just want to die." For the nurse to comply with this request, the nurse should discuss
Advance directives. pg298 rationale: patient autonomy over end-of-life decisions In addition to patient refusals of treatment, the nurse frequently encounters a DNR order. DNR means "do not resuscitate" or "no code." Documentation that the health care provider has consulted with the patient and/or family is required before attaching a DNR order to the patient's medical record (Guido, 2010). The health care provider needs to review DNR orders routinely in case the patient's condition demands a change. If a patient does not have a DNR order, health care providers need to make every effort to revive the patient. CPR is an emergency treatment provided without patient consent. Health care providers perform CPR on an appropriate patient unless there is a DNR order in the patient's chart.
Teaching method
Affective: role play, discussion (one-on-one or group)
AAPIE
All phases of the nursing process
Facilitate Mourning
Allow time to grieve. "Anniversary reactions" (i.e., renewed grief around the time of the loss in subsequent years) are common. A return to sadness or the pain of grief is often worrisome. Openly acknowledge the loss, provide reassurance that the reaction is normal, and encourage the survivor to reminisce.
Female orgasmic disorder
An Orgasm Phase Disorder: -Persistent failure to reach orgasm, experiencing orgasms of very low intensity or delay •Almost 24% of women it appears ^ -10% or more have never reached orgasm -9% reach orgasm only rarely •Sexually assertive women & being more comfortable with masturbation tend to have orgasms more regularly •Female orgasmic disorder is more common in SINGLE women than in married or cohabiting women
Premature ejaculation
An Orgasm Phase Disorder: -Persistent reaching of orgasm and ejaculation within one minute of beginning sexual activity with a partner and before he wishes to •As many as 30% of men experience rapid ejaculation at some time
Delayed ejaculation
An Orgasm Phase Disorder: -Repeated inability to ejaculate or by a very delayed ejaculation after normal sexual activity with a partner •Occurs in 8% of the male population
LSBN
An administrative agency of the state composed of 9 registered nurses
Duty
An obligation to use due care, do what you are suppose to do or not do
Phase 2 nursing process
Analysis and identification of the problem
Onset age for anorexia vs. bulimia:
Anorexia: 14-18 years (when body is changing) Bulimia: 15-21 years
Assault
Any threatened or implied act, whether carried out or not
Successful Communication
Appropriate: timing, place, situation Efficient: clear and simple Flexible: learn to change your approach with each patient Includes feedback Clarify persons perceptions of your message: ALWAYS
When was HIPAA put into action?
April of 1996
A nurse informs the patient's health care provider that the patient is refusing potentially life saving surgery. In this situation, which ethical principle is the nurse using?
Autonomy
A patient states that he "feels weak, like a rag" and "doesn't think anyone cares if I live or die". This is an example of what phase of the nursing process? A. Analysis B. Assessment C. Assurance D. Association
B-Assessment
A patient in whom renal failure is diagnosed, requiring him to start dialysis tells the nurse, "I think that I just need to drink more water and eat better." The nurse recognizes that the patient's illness behavior is being influenced by which factor? A. Anger B. Denial C. Depression D. Spirituality
B-Denial
Developing leadership skills, certification and continuing education, political activism and practice guidelines and position statements are all benefits of: A. Political policy B. Belonging to professional associations C. HIPPA D. WHO
B-belonging to a professional association
Virginia Henderson Basic Needs
Basic nursing care involves 14 activities: Physiological, Spiritual and Sociological Said to pay attention to the person and listen!
Orem-Self Care
People want to be in control of their lives. Promote independence
Assault carried out. Impermissible, unprivileged touching of one person by another. Actual harm may or may not occur.
Battery
Philosophies are based on:
Beliefs-- demonstrated thru behavior, acceptance of something you believe to be true, experiences, convictions, attitudes
Level of research: Identifies problems, may do data collection
BSN
Causes of Erectile Disorder
Biological - (1) Same hormonal imbalances that cause hypoactive sexual desire disorder produce ER (2) Vascular problems (3) Damage to the nervous system by disease, disorder, injury (4) medications/substances Psychological - (1) any psychological causes that cause male hypoactive desire disorder can lead to ED (2) Depression - 90 percent of men with severe depression experience some degree of ED Cognitive - perspective emphasizes anxiety & spectator role (man with ED may be nervous about performing which leads him to act as spectator/observing) Socio-cultural: stress
Causes of Delayed Ejaculation
Biological causes: - Low testosterone, neurological disease, head/spinal cord injury - Medications, including certain antidepressants (especially SSRIs) & drugs that slow down the sympathetic nervous system Psychological causes: -Performance anxiety & spectator role, the cognitive factors involved in ED (lead cause) -Past masturbation habits -This disorder also may develop out of male hypoactive sexual desire disorder
Causes of Male hypoactive desire disorder & Female sexual interst/arousal disorder
Biological: (1) hormone abnormalities resulting in lower sex drive -- (ex: prolactin, testosterone, and estrogen in both men and women) (2) excessive activity of neurotransmitters serotonin and dopamine (3) medications Psychological: anxiety, depression, anger Socio-cultural: attitudes, fears of sex, stress, trauma
Florence Nightingale
Born in 1920 to aristocratic family Reformed British army hospitals
Types of Organizations
Broad: purpose Professional Organizations "ANA" Specialty Practice Associations: "AORN" Special Interest Associations: "Sigma Theta Tau"
Child abuse
Bruises & welts, lacerations & abrasions, skeletal injuries, head injuries, repeated injuries, aggressive behavior, different excuses for cause of injury.
A nurse checks in on his patient and notices that the patient has removed the oxygen from her nose and has rapid shallow breaths. The nurse knows the best way to treat the patient is to check the patient's oxygen saturation, replace the nasal cannula, and raise the patient's HOB based on... A. The research process B. Nursing practice C. Evidence base research D. Critical thinking
C-Evidence based research
A 78 year old man is in the hospital with end-stage liver failure. His level of cognitive abilities have diminished. He frequently attempts to get out of the bed to go to the "kitchen" and has become combative. He is a fall precaution so the nurse, per hospital policy, places him on a bed alarm, applies mittens, and gets him a sitter. The patient's long-time neighbor comes to visit, becomes upset seeing his long-time friend in this situation, and demands to see the patient's char. What should the nurse do? A. Show him the doctor's orders B. Tell him it's none of his business C. Advise him to speak with the patient's wife D. Direct him to the unit secretary
C-advise him to speak with the patient's wife
Medically indigent
Do not qualify for Medicaid but cannot pay for health care
Process of Valuing:
Choosing: think about alternatives and consequences Prizing: affect, what do you feel about that choice? Acting: behavior, do you play out your values? Your nursing care: do you demonstrate your value system?
Protect security of patient data
Electronic era with patient data stored in many different ways, transmitted in many forms, & with many means of access
Exceptions
Emergency (life or death) sign later
Euthanasia
Performing a deliberate action that results in a painless, easy death for individuals w/ an incurable disease; same as mercy killing
Components of Collaboration
Emotional maturity, respect for all, confidence, team spirit, value, knowing limits, effective communication skills, self-awareness
working poor
Employed but cannot make enough money to provide for the family
Nursing Theory Prescriptive -Ernestine Wiedenbach
Central purpose- the philosophy, culture, individuality of the patient and nurse - the interactive plan of care for the patient - the patient, nurse, environment, goals, etc.observes, ministers and validates
What's the difference between licensure and certification?
Certification: validation of specific competencies demonstrated by a registered nurse in a defined area of practice Licensure: The process by which an agency of government grants permission to qualified persons to engage in a given profession or occupation. *Licensure refers to state regulation of nursing *Certification goes beyond licensure by showing high knowledge in particular are.
CNM
Certified Nurse Midwife Well-woman care and assist with childbirth Formal education programs-at least nine months
Licensure
Certifies that an individual has attained MINIMAL DEGREE OF COMPETENCY
ICDM-10
Code used for patient diagnosis; International Classification of diseases, 10th edition
CPT
Code used for physician services; Current procedural terminology
Male hypoactive sexual desire disorder
Characterized by a lack of interest in sex and little sexual activity •16% of men - Physical responses may be normal *Affects desire phase
Erectile disorder (ED)
Characterized by persistent inability to attain or maintain an erection during sexual activity -As much as 10% of the general male population -According to surveys, 50% of adult men have erectile difficulty during intercourse at least SOME of the time
Hard copy guidelines
Charts/records must be: Isolated from public Not left unattended Secured when not in use by lock and key, security I.d. or key card Monitor fax machine Shred notes and discard
the nurse's legal responsibilities with regard to reporting abuse
Child Abuse Prevention and Treatment Act and Reporting Statutes: Mandate reporting specific health problems and suspected or confirmed abuse Health professionals must report under penalty of fine or imprisonment for failing to do so: • Infant and child abuse • Dependent elder abuse • Specified communicable diseases
Process of Valuing
Choosing: from alternatives, considering consequences Prizing: feeling about a choice Acting: behavior "acting on values" Your nursing care: demonstration of what you value
The nursing sole under OREM during nursing interventions act as a _________
nurse agency
paraplegia
paralysis from the waist down caused by damage to the lower level of the spinal cord
Nursing Theory Cultural Diversity and Universality -Madeleine Leininger
Caring is a universal phenomenon but varies trasnsculturally 1- the worldview and social systems 2- individuals, families, groups and institutions 3- folk systems, professional systems and nursing Level 4- decisions and actions
Nursing Theory Human Caring -Jean Watson
Caring is amoral ideal and entails the body-mind-soul engagement with one another. made seven assumptions about the science of caring: it can be demonstrated and practiced; it results in satisfying human needs; that it promotes health; it accepts the person as is; the person choices to act on his own; it is "healthogenic" and more of the person than curing; it is central to nursing.
5 C's to prevent lawsuits
Caring, Competency, Communicating, Charting, Committed to prevention of medical errors
CNS
Clinical Nurse Specialist Masters or doctorate Assess, diagnose, and treat as well as consultants, educators, administration
CRNA
Clinical Registered Nurse Anesthetist 2-3 years of additional education, 1-2 years in critical care
Questions: Open and Closed
Closed: inefficient, can be answered with yes or no, "do you feel sad?" Open: "How do you feel..?" "Could you tell me more?"
ANSI X12N
Code for all claims & eligibility transactions; American National Standards Institute's
Critical Thinking Continued
Cognitive process and an attitude (the way you approach a problem) Necessary for nursing practice for good clinical judgement Reasoning is another word for critical thinking
2. Negativity/independence
Cognitive rebellion; diminished reliance on external authority
Teaching method
Cognitive: discussion (one-on-one or group), lecture, question-and-answer session, role play, discovery, independent project, field experience
4. Interdependence
Collaborative decision making; commitment to professional role; self-concept now includes professional role identity
Nursing
Combines the preceding concepts Includes non-judgemental attitude, helps people maintain their health, receive maximum ability, involves education, good communication, advanced skills
Feedback
Communication within the system. Important!
Elements to Prove Malpractice
Compensatory damages Punitive damages (punish the reckless caregiver) Delegation 5 R's Negligence
Complementary
Complementary—therapies used in addition to conventional treatment (aka integrative therapies)
Confidentiality
Containing secret information (medical records)
Privacy rule
Controls access by placing limits on who is allowed to see patient records and what they are allowed to do with the information
In orem's model of nursing the _______ operation is the planning stage for formulating a plan of care
prescriptive
Unique identifiers
Create a code to identify patients; both control who has access to patient records
Leininger's Theory of Culture Care
Culture care, developing awareness and sensitivity, planning nursing care based on cultural beliefs and knowledge
Mercy killing
Performing a deliberate action that results in a painless, easy death for individuals with an incurable disease
Constitutional Law
Defines the relationship between governmental authority and individual freedom
Sexual Dysfunctions
Disorders in which people cannot respond normally to key areas of sexual functioning; problems with sexual response
cultural values
Do not force persons to participate in care that conflicts with ___________ ____________
Inference
Draw conclusions that are based on evidential data and are logical given the client situation
personal choice, obligation
Ethical decision making is not a(n) ______ ______ but a(n)________ of the professional nurse
Nursing Model Health Care Systems -Betty Neuman
Each person is a complete system; The goal of nursing is assist in maintaining client system stability Types of stressors- intrapersonal, interpersonal, and extrapersonal types of prevention- preventive, corrective, and rehabilitative. of resistance- internal factors that defend against stressors. helps the person when stressors occur.
Define secondary prevention.
Early screening and detection. Not doing anything to prevent the problem. Ex: mammogram, taking blood pressure
Registered Nurse Safe Staffing Act 2010
Empowers nurses to drive staffing decisions in hospitals
What does output consist of?
End result, product, or outcome
Disorders of Sexual Pain
Enormous physical discomfort during intercourse; does not fit into any specific stages of the response cycle Collectively called genito-pelvic pain/penetration
Nightingale believed that health was related to what?
Environment- you must protect the patient by controlling their environment
Sociocultural factors
Environmental, social, and cultural stressors perceived by children, adolescents, and adults
Ethical principles: Justice
Equals should be treated the same and unequals should be treated different
the purpose of ethical principles
Establish common ground between nurse, patient, family, other health care professionals, and society to discuss ethical questions and make ethical decisions
Ethics & laws
Ethics provide ls the general principles on which laws are based, and laws are a means of enforcing ethical principles
Professional Socialization
Every profession has a socialization process, it is the ability to think and act like a professional nurse, absorb the culture of the profession, the process where students internalize new knowledge, skills, attitudes, behaviors, and values, and make these a part of their professional identity
Archi Cochrane is credited for?
Evidence Based Practice
Defined as an approach to the delivery of health care that "integrates the best evidence from expertise and patient preferences and values"
Evidence Based Practice
Analysis
Examine the findings in relation to the situation and gather additional data as needed to validate the findings
Which branch of the government implements laws?
Executive branch
Roles are affected by:
Expected behaviors, values, knowledge, environment, mentors, ethics and legal boundaries
Foundational Thinking in Clinical Practice
Expected signs and symptoms of an illness, expected reference range for laboratory results, risk factors for an alteration in health, expected and side effects of a medication or treatment, nursing interventions that are appropriate to help meet a specified client need
dyspareunia
Experienced by women with genito-pelvic pain/penetration disorder --> severe vaginal or pelvic pain during sexual intercourse Physical causes; commonly from childbirth
Highly organized, has vast amounts of experience Assess and considers different options Knows which rules are flexible More self confident and less anxious Are challenged by novices' questions Has a better idea of suspected problems
Expert
suicide
Explain the safety goals of identifying patient safety risks.
• get important test results to the right staff person on time to use medicine safely
Explain the safety goals of improving staff communication.
handwashing guidelines
Explain the safety goals of preventing infection.
the ANA Nursing's Social Policy Statement
Expresses the social contract between society and the profession of nursing...a framework for understanding professional nursing's relationship with society and its obligation to those who receive professional nursing care.
1. Common Negligent Acts
Failure to assess and/or monitor, including making a nursing diagnosis Failure to monitor in timely fashion Failure to use proper equipment to monitor the patient Failure to document the monitoring Failure to notify the health care provider of problems Failure to follow orders Failure to follow the six rights of medication administration
2. Common Negligent Acts
Failure to convey discharge instructions Failure to ensure patient safety, especially for patients who have a history of falling, are heavily sedated, have disequilibrium problems, are frail, are mentally impaired, get up in the night, and are uncooperative Failure to follow policies and procedures Failure to properly delegate and supervise
A nurse checks a patient's blood sugar and administers the ordered medication before instructing a coworker that he was going on his lunch break. The patient alert's their call light and tells the covering nurse that his blood sugar was checked but they never received their insulin shot. What category of negligence does this situation represent? A. Failure to communicate B. Failure to follow standards of care C. Failure to document D. Failure to assess or monitor
Failure to document
Negligence
Failure to meet the standard of care that can be reasonably expected from a person with certain training & experiences
Ethical principles: Fidelity
Faithfulness or honoring one's commitments or promises
True or False: the ASBN has the ability to Deny, suspend, revoke or limit any license or privilege to practice due to any of 7 causes?
False (6 causes)
What are the Social, Political, and Economic factors of nursing? (8)
Feminism Women's Movement Consumer Movement Graying of America Cultural Diversity Men in Nursing Violence Technological Advances
Social, Political, Economic Factors
Feminism, Women's Movement, Consumer Movement, Graying of America, Cultural Diversity, Men in Nursing, Violence, Technological Advances
What is health promotion?
Finding ways to help individuals develop a state of physical, spiritual, and mental well-being. Activities to encourage optimal functioning.
Acute care safety
Fires: "RACE" and "PASS" Rescue patients. Activate alarm. Confine fire. Extinguish.
ICN
First international organization for all medical professions
Eddie Bernice Johnson
First nurse elected to U.S house of reps
Right task, Right circumstances, Right person, Right communication, Right supervision
Five Rights of Delegation
Trait Approach
Flexner (sociologist who said the following are most important professional traits) 1. High intellectual activity and high individual accountability 2. Knowledge gained thru research 3. Theoretical knowledge et practical knowledge 4. Specialized education in university or college 5. Strong internal organization that guides (code of ethics) 6. Motivated by service of altruism
Trait Approach
Flexner, Bixler, Pavalko- sociologists who determined the following characteristics to be most important professional traits 1. high intellectual activity 2. high level of individual accountability/responsible 3. specialized body of knowledge 4. education in a 4 yr. college/university 5. focus on service and alturism 6. valued over financial gain 7. atonomy in independence 8. strong organization represents their group 9. code of ethics
Which philosopher recognize nursing's role in protecting the patients?
Florence Nightingale
In a malpractice lawsuit a nurse's actual conduct is compared to nursing standards of care to determine whether the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances
For example, if a patient receives a burn from a warm compress application, negligence is determined by reviewing if the nurse followed the correct procedure for applying the compress. A breach of the nursing standard of care is one element that must be proven in the tort of nursing negligence or malpractice
Teamwork and Collaboration
Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care. Examples: Recognize the contributions of other health team members and patient's family members. Discuss effective strategies for communicating and resolving conflict. Participate in designing methods to support effective teamwork.
A nurse is working in a neonatal intensive care unit (NICU) where a premature baby (26 weeks gestation) is facing respiratory disorders, numerous infections, and a brain hemorrhage. The parents want every measure to be taken to keep their baby alive, but several members of the health care team are advocating removal of life support. The nurse believes there are several ethical issues involved in this case. What step should the nurse take first when facing an ethical dilemma?
Get as much information possible about the situation
Many states have adopted special statutes to deal with issue of ____ & ____
HIV and disclosure
Open System
Have interaction with other systems and the environment, this is the most common!
HIPAA
Health Insurance Portability and Accountability Act of 1996
Media Impact on Nursing
Image of Nursing, TV, movies, newspapers Promote positive image by: nursing uniforms, communication, and tell others what nurses do
Bachelors
Health assessment, leadership/mgmt, research, public/community health/ teaching an advocacy
Patient self-determination act of 1991
Health care facilities must provide adult patients w/ info about advance directive upon admission
Limitations in Nursing
Health care settings cant be a controlled settings, human beings are complex and cant be studied objectively- data is subjective, ethical issues become important
Nursing Theory Health as Expanding Consciousness -Margaret Newman
Health encompasses conditions described as illness (the precursor of the Health Illness continuum). of pathology in itself will not change the pattern of the individual. is the expansion of consciousness.
Patients may see and obtain records within 30 days of request Providers must give patients written notice describing rights to privacy. Patient's must be asked to sign papers agreeing to these policies Limitations are placed on the length of time records can be retrieved, what information can be shared, and who can be present when it is shared
Health insurance portability act
Health
Health is more than the absence of disease! A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO, 1947) A state of being that people define in relation to their own values, personality, and lifestyle
Nursing Process: Implementation
Health promotion Regular exercise Support systems Time management Guided imagery and visualization Progressive muscle relaxation Assertiveness training Journal writing Stress management in the workplace
Educator and Counselor
Health promotion and maintenance Encourage clients to look at alternatives, make choices, and maintain sense of control
Committed to prevention of medical errors
Healthy environment lead to less medical errors.
How to become a better listener
Hearing: actually hear and receive Understand: mindful and present Remember: so it can be used for later interactions Interpreting: clarifying the message Evaluating: is their message true or accurate
Which philosopher linked their definition of nursing that emphasized functions of the nurse with a list of basic patient needs that are the focus of nursing care
Henderson
Nursing Theory Theory of Conservation Myra Levine
Her idea was that we need to help the person conserve energy; structural integrity; personal integrity; and social integrity. It is a very holistic theory. believed nursing is a discipline the basis of which is the person's dependence and relation to others. is the ability to maintain integrity.
decisions, opinions, and creeds
How are beliefs expressed?
How does the media impact nursing?
Image: handmaidens, angels of mercy, sex symbols, bimbos TV shows, movies, newspapers, magazine, advertisements
Who wrote "A Theory for Nursing Systems, Concepts, Process"
Imogene King
Who's conceptual model focuses on people, their interpersonal relationships, and their social contets
Imogene King
A student nurse employed as a nursing assistant may perform care
Identified in the hospital's job description for nurse's aide
Kanter
Identified three factors that are limiting the influence of women in decision making and influencing policy
Nursing Interventions with Angry Patient
Identify why patient is angry Plan of care that involves patient (sense of control) Use incentives and withdrawal of privileges Interventions to decrease anxiety Provide education Set limits Promote trust by providing immediate feedback
• Explain the need for a blame-free culture of safety.
If staff members feel comfortable reporting errors or near misses, systems could be better fixed. Because they do not feel comfortable they do not come forward with information and therefore the vicious cycle of the broken system keeps being used because no one knows it's broken. This can cause a more serious error to occur later down the road
Experience Improves Clinical Judgement
Improves as the steps of the clinical decision-making process are done simultaneously such as listening, evaluation, selecting best nursing action, collecting data, interpretation of data
specific techniques
In addition to the general components of sex therapy, specific techniques can help in each of the sexual dysfunctions
Specific techniques for Female orgasmic disorders
Include: - Cognitive-behavioral techniques - Self-exploration - Enhancement of body awareness - Directed masturbation training •Biological treatments - hormone therapy or the use of sildenafil (Viagra), have also been tried, BUT research has not found to be consistently helpful •Female orgasmic disorders -Again, a lack of orgasm during intercourse is not necessarily a sexual dysfunction, provided the woman enjoys intercourse and is orgasmic through other means •For this reason, some therapists believe that the wisest course of action is simply to educate women whose only concern is lack of orgasm through intercourse
from 1850 - now, has social organization and public policies on health care issues increased or decreased?
Increased.
• Identify programs used to reduce preventable medical errors
Institute of Medicine (IOM) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Power Approach
Independence and Control! Ability to make things happen
Pender's Health Promotion Model
Individual characteristics: prior related behaviors, personal factors (age, women, education, income) Behavior specific thoughts: perceived benefits, barriers, self efficacy (time, income, inconveinence access)
Ethical principles: Autonomy
Individuals have the right to determine their own actions and the freedom to make their own decisions
Define perceived role.
Individuals own definition of the role. More realistic than ideal role. "All nurses should be kind, caring, empathetic..."
Prior authorization
Info forwarded to 3rd party
Florence Nightingale
Initiator of major reforms in healthcare and nursing training in England.
Components
Input: energy that helps achieve the purpose of a system Throughput: system makes sense of something Evaluation: how effective it is Feedback: continuous communication within system
Characteristics of a Critical Thinker
Inquisitive Collects/assess relevant information Makes conclusions and solutions that are thought out Open minded, recognizes alternative ways Communicates effectively
Dependent interventions require?
Instruction and supervision
What is service learning?
Instructional method that combines community service and academic instruction and focuses on critical reflective thinking and civic responsibility
Rationing care and resources
Insurance companies decide what care is covered.
Evidence-Based Practice
Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Examples: Demonstrate knowledge of basic scientific methods. Appreciate strengths and weaknesses of scientific bases for practice. Appreciate the importance of regularly reading relevant journals.
HIPPA
Intent of this law is to ensure confidentiality of the patient's medical records; the statute sets guidelines for maintaining the privacy of health data
Homeostasis
Internal stability, maintaining the necessary levels
Information Technology
Internet, electronic records, telehealth. Clients are better informed, transmit client information electronically, connect rural clients to specialists
Peplau's Theory of Interpersonal Relations in Nursing
Interpersonal relationships, developing trust with the patient, involves different roles of the nurse
Context and Types of Communication
Interpersonal: between 2 people Small Group Interprofessional Collaborative Communication: between other healthcare professionals Public: audience Mass Communication: electronic, though the internet
Legal
Is malpractice civil or legal?
How has the War on Terrorism affected nursing?
It has brought about an increased need for nurses Mental health practitioners are in demand
Which theorist stated that " the relationship between patient and nurse is the focus of attention, rather than the patient only as the unit of attention."
Peplau
On a medical unit, several patients are being treated for Hepatitis B infection. One of the patients contracted Hepatitis B through using infected needles associated with heroin use. Another of the patients contracted Hepatitis B through a blood transfusion following a car accident. Several of the employees on the unit treat the patient who used heroin rudely and delay their attention to the patient's requests. The nurse intervenes and reminds the staff to use which ethical principle?
Justice
Which ethical principle is not matched with it's correct definition? a. Beneficence-duty to maximize good b. Nonmaleficence-duty to avoid, prevent or minimize harm c. Justice-keeping a promise d. Veracity-telling the truth e. Autonomy-self determination
Justice (should be: Justice-fairness and equity Fidelity-keeping a promise)
Analysis of Clinical Reasoning
Key cognitive skill of a critical thinker. Involved scrutinizing all data, determining the importance of each piece, distinguishing relevant from irrelevant data
_____ process provides a structure for the nurse to monitor the relationship's progress toward the goal of the patient regaining health
King's
__________ interacting systems form a framework to view the whole person
King's
Verbal guidelines
Know with whom you are speaking or sharing info Don't discuss PIIHI in public Close door Lower voice
Competency
Know your obligations and responsibilities, legally, ethically, professionally and incorporate into daily practice. Stay current and practice within your scope of practice and personal competence areas. Provide good quality of care.
Intuition
Knowing something w/o hard evidence, must not depend solely on this to make nursing judgement Use intuition to send up a "red flag"- pay attention to this feeling but gather more data and look for evidence to support your intuition
Assertiveness Ladder
L= look at own rights and needs A= arrange a time D= define the problem D= describe your feelings E= express your request simply R= reinforce the possibility of getting what you want
Who believed that all nursing is based on the interpesonal process and the nurse-patient relationship?
Peplau
Disorders of Desire: Male hypoactive sexual desire disorder (16%)
Lack of interest in sex and little sexual activity -Physical responses may be normal
What is the common fund?
Largest source of public funding for health related research that collaborates with 27 scientific centers. NIH roadmap
Federal law
Protects privacy
Auditory Learners
Learn best by hearing, verbal repetition, tapes, lectures, like to talk things through, listen to others, dislikes working quietly for a long time, easily distracted by noise and silence Read text aloud, use a tape recorder in class, record summary of notes, create songs, study in groups
Tactile Learners
Learn best by touching and doing, projects, concept maps, simulations, role-playing, easily distracted from learning, enjoy using computer Simulation, create models or displays, practice kits with equipment, be active during scheduled breaks
Why is professional socialization important
Learn professional behaviors, enhances professional commitment, improves our (nursing) image, learn the profession's expectations of its members
Responsdeat superior
Legal doctrine that makes an employer responsible for the behavior & actions of his or her employees
Informed Consent
Legal standard, the minimum standard that patients can expect to receive
Nurse Practice Act
Legally defines and describes the scope of nursing practice
Who wrote " Journal of Transcultural Caring"
Leininger
Under ___________ theory patients must be viewed in the context of their culture in order to provide good care
Leininger's
_________ theory of cultural care is used to provide care which is considered culturally congurent
Leininger's
cirrhosis
Liver damage - An alcohol consequence
Where was the first training school that Florence established?
London
Statutory Guidelines for Legal Consent for Medical Treatment
MINORS For his or her child and any child in his or her legal custody B. For himself or herself in the following situations: 1. Lawfully married or a parent (emancipated) 2. Pregnancy (excluding abortions) 3. Venereal disease 4. Drug or substance abuse
What are some key concepts of nursing?
Maintain health. Be an educator. Importance of communication. Being non-judgmental.
Failure to follow standards of care Failure to use equipment in a responsible manner Failure to communicate Failure to document Failure to assess or monitor Failure to act as a patient advocate
Major categories of Negligence
Case Study: Dying with Stage IV Pressure Ulcer
Many possible patient rights encompassed by each of the described provisions of the 2001 code of ethics for nurses from the ANA were failed to be honored. Provision 1: compassion, respect, dignity, uniqueness of individual - be appropriate and respect Mr. Daly 2. ANA code of ethic: primary commitment to patient! 3. Promotes, advocates to protect health, safety, rights of patient - honor right to pain relief 4. Accountable for individual nursing practice, appropriate delagation !!
Compare and contrast the health care coverage/benefits included for patients who receive Medicare and Medicaid. (See pp. 350-351)
Medicare (all federal) - Available to people age 65 and older regardless of income. - Covers certain disabled individuals and anyone with permanent kidney failure requiring dialysis or a kidney transplant. - Nationwide - Payment required Medicaid- Jointly funded state and federal programs for low income elderly, blind and disabled individuals. - Vary by state - Payment not required usually
Meditation and Breathing
Meditation is any activity that limits stimulus input by directing attention to a single unchanging or repetitive stimulus, so the person is able to become more aware of self. Lowers oxygen consumption, reduces respiratory and heart rates, and reduces anxiety Lowers blood pressure (BP) in hypertensive patients and lowers breathing rates in asthmatic patients and in cancer patients
Clinical Reasoning
Mental process used when analyzing all the elements of a clinical situation and making a decision based on that analysis. Supports by guiding the nurse through the process of assessing data, selecting and discarding bits of data, making decisions based on nursing knowledge
Treatments for Sexual Dysfunction
Modern sex therapy (cognitive approach) - 15-20 sessions
Damages
Money to compensate for an injury or loss
Justice
Moral rightness, fairness, or equity
Established rules of conduct to be used in situations where a decision about rights and wrongs must be made
Morals
Anorexia Nervosa
Morbid fear of weight gain Refusal to maintain more than 85 percent of bodyweight -Intense fear of becoming overweight -Distorted view of weight and shape -Amenorrhea - no menses -Typical case: "perfectionism", "over-achievers" Despite dietary restrictions, people with anorexia are pre-occupied with food (thinking, etc.)
Healthy People 2020
National 10 year health promotion for Americans, Assess health risks, public priorities, preparedness and prevention
________ has created a list of accepted diagnostic labels/ suggested terms for suggested health problems which can e identified and treated by nurses
NANDA
The ________ stated that the power of the nurse comes from the professional position and the access to private knowledge about the client
NCSBN
The ___________ defined professional boundaries as the spaces between the nurse's power ad the client's vulnerability.
NCSBN
Operations of Communication
Perception: interprutation of message Evaluation: Do I think what your saying is important? Transmission: how you express you ideas (enthusiasm, boredum, confidence
Requirements of Clinical Reasoning
Nurse simultaneously analyze and evaluate assessment data during its compilation, uses the retained data to begin drawing a conclusion about the situation, supports the clinical decision-making process
Demographic data (PIIHI)
Name, address, SS #, date & place of birth
What impacts did WWI have on nursing?
National campaign to recruit nurses Established Army School of Nursing Initiated public health education and home nursing through Red Cross
Virginia Trotter Betts
National nurse leader, mental health policy
Hallucinogens (psychedelic drugs)
Natural: - Mescaline, Psilocybin Laboratory-produced: - LSD, MDMA (ecstasy)
Organ transplants
Need prior authorization from patient before death, or family members after death.
Closed System
No interaction outside of the home. Could the patient be neglected, using drugs? etc.
Anorexia nervosa cause of death:
Not from malnutrition BUT cardiac arrest! - electrolyte levels are off; muscles cannot function * Of all psychiatric disorders, mortality rate is the highest for anorexia 2-6% die (medical or suicide)
Knowledge as separate facts Focus on actions Follow clear cut rules Unawareness of resources Anxious lack of self-confidence
Novice
NP
Nurse Practitioner Master's degree Works in clinics, nursing homes, office, HMO, industry Specializes in: peds, adult, family, gerontology
Describe the nurse's legal accountability and responsibility in relation to the provision of care.
Nurse is legally accountable for: - All nursing care and interventions, including the administration of medication - Knowing the standards of care, normal parameters of health, knowledge about the medications being administered, - Any procedures for which she is responsible for performing.
Interdependent
Nurse must colloborate
Manager
Nurses are responsible for the management and coordination of client care. o Delegate, collaborate, consult o All nurses need good management skills, whether they supervise others in the provision of nursing care or whether they provide direct care themselves.
• Discuss the roles of nurses and nursing as a profession in improving health care.
Nurses serve on the Joint Commission Nursing Advisory Council, which advises the Joint Commission about nursing concerns and care issues related to safety and quality. Nurses are very involved in the surveying of the HCO. These are asked questions and are included in meetings to discuss care in the HCO.
Critical Thinker
Nurses use decision-making and critical thinking skills in conjunction with the nursing process. o Before actually delivering nursing care, the nurse determines the best method of care delivery for each client. o The nurse's plan of care is based on consideration of all aspects of the situation and thinking through alternative strategies to achieve a number of possible outcomes.
What did the nurses do in the Vietnam War?
Nurses worked without direct MD supervision They performed emergency procedures on their own
____________ are the standardized activities the nurses preform to assist patients in meeting their outcomes/goals
Nursing Interventions Classifications (NIC)
Margaret Newman
Nursing care is aimed toward reducing stress factors that might affect optimal patient functioning; systems model; lines of defense. relationship to stress, reaction to it, reconstruction factors. primary, secondary and tertiary preventions
Nursing Process: Diagnosis (teaching)
Nursing diagnoses for patient education Deficient knowledge (affective, cognitive, psychomotor) Ineffective health maintenance Impaired home maintenance Ineffective family therapeutic regimen management Ineffective self-health management Noncompliance (with medications)
Sister Callista Roy
Nursing interventions are needed when individuals demonstrate ineffective adaptive responses; adaptive modes. adaptation model, relationships between persons, universe, god, Adaptation model: assistance with the adaptation to stressors to facilitate the integration process of the client. Theory helps the "biospsychosocial" client modify external stimuli, adaptation will occur
Dorothea Orem
Nursing is a human service, and nurses design interventions to to provide or to manage self-care actions for sustaining health or recovering from illness; Self-care deficit model: self-care, self-care deficits, and nursing system. Theory is to restore the client's self-care capability to enable him or her to sustain structural reliability, performance, and growth through purposeful nursing intervention
Roy's Adaptation Model
Nursing promotes peoples' ability to adapt to changes
Researcher
Nursing research provides the evolving body of knowledge and theory for our profession. o Nurse researchers may be employed in an academic setting, a community service, or an independent professional agency. o The nurse researcher usually conducts studies and investigates problems to improve client health and nursing care.
Level of research: Learns about research, honors project, or assist in lab
Nursing student
Contracts contain 3 parts
Offer Acceptance Consideration
Communicator
Open and consistent communication is vital for effective nursing practice. o The nurse must possess excellent communication skills to provide care, rehabilitation, teaching, comfort, and protection to clients.
In ______ model of nursing, appropriate care for the patients is developed though a series of three operations.
Orem's
Nursing Theory Interpersonal Relationship- Hildegard Peplau
Orientation- patient seeks assistance from nurse - patient responds to nurse who intervenes to assist - patient uses services offered -therapeutic relation ends
Who wrote "The Dynamic Nurse- Patient Relationship: Function, Process and Principles" ?
Orlando
Under _________ theory, the goal of the nurse is to determine and meet patients' immediate needs and to improve their situation by relieving distress and discomfort
Orlando's
A group of nurses is concerned with patients who have developed postoperative infections. The group is reviewing research literature. One research article concludes that providing written material with illustrations, along with the previously provided verbal instructions, has reduced the incidence of infections. When the nurses are using PICO as a framework, what is being described?
Outcome
Bulimia Nervosa
Over-eating during a limited period of time & compensating for eating by: - Forced vomiting - Laxative use - drugs that induce bowel movements - Diuretics - drugs that remove water from the body by increased urination - Enemas - a process that expels waste from the body by injecting liquid into the anus - Fasting - Excessive exercise
The _________ part of the diagnostic statement is a concise statement of the problem
P (problem)
What is the three part statement needed when concluding a nursing diagnosis?
P (problem) E (etology) S (signs and symptoms)
What does PICO stand for
P-population of interest I-Intervention C-Comparison O-Outcome
Each person has legal and moral rights to informed consent about medical treatments with a focus on a person's right to choose
Patient Self Determination act
Forms of Negligence
Patient falls, improper technique of treatment, burns, medication errors, failure to respond to call lights, failure to communicate, failure to supervise properly
• Invasion of patient privacy
• Concerns access to a person's body or behavior without consent
Consent
Patient must give consent. Can be given by: mentally competent adults - 18yrs or older Emancipated minor - under financial aid, married, or in military
Adapting Communication Techniques
Patients who cannot speak clearly Cognitive impairment Hearing impairment Visual impairment Unresponsive Patients who do not speak English (or your language)
Medicare Parts
Part A- inpatient hospitalization, skilled care Part B- office visits Part C- managed care option Part D- medications
the purpose of and requirements for nursing licensure.
Passage of NCLEX, fees, criminal background check, CE contact hours within a specified time period, active employment for a specific number of hours within a specified time period (renewal), and number of hours of professional nursing activities (renewal).
Implied consent
Permission for procedures indicated by the patients actions. Ex: showing up for a medical appointment.
Express consent
Permission that is given in writing
Female Orgasmic Disorder - 24% have problem - 10% or more have never reached orgasm - 9% achieve it but rarely
Persistent failure to reach orgasm, experiencing orgasms of very low intensity or delay in orgasm Biological: same medications/substances affecting men affect women; medications Psychological: (1) depression (2) Memories of childhood trauma (3) relationship distress
Premature ejaculation 30%
Persistent reaching of orgasm and ejaculation within one minute of beginning sexual activity with a partner and before he wishes to
Gender Dysphoria
Persistently feel that they have been assigned to the wrong sex; want to get rid of primary and secondary sex characteristics and acquire characteristics of other sex Men outnumber women with this disorder 2 to 1 Often experience anxiety, depression, suicidal thoughts
4 Domains of Nursing
Person, Health, Environment, Nursing
What are the basic concepts/domains of nursing?
Person, Health, Environment, Nursing
Morals
Personal standards of right and wrong that are usually learned during childhood and based on religious beliefs through which there is societal influence; it is often manifested as behavior in accordance with group norms i.e.: polygamy in the Mormon traditions
Level of research: Generates and tests theory
PhD, DNP, EdD, DRPH
3 forms of elder abuse
Physical mistreatment Mental & emotional abuse Abandonment
Content of Nursing Knowledge
Physiology and patho, pharmacology, nutrition, nursing procedures, mathematics, information technology, legal issues, ethical issues, effective communication
Disorders of Orgasm
Premature ejaculation Delayed ejaculation Female Orgasmic Disorder
Assertive Listening
Prepare: tune into own feelings and needs Engaged: listening-put full attention on the other person (ask for clarification) Acknowledge: let the other person know you heard his/her feelings and wants
Confidentiality
Preserving the legal right of the patient to privacy concerning his or her medical affairs
Define primary prevention.
Prevent or slow the onset of a disease. EDUCATE.
Code of ethics
Principles created by professional organization to serve as a guide for the conduct of health care professionals in that occupation.
Philosophy is the study of:
Principles that underlie professional conduct What's accepted by a profession What guides a profession
Malpractice
Professional negligence
Malpractice
Professional person is judged against professional standards and practices of another reasonable, prudent professional person with similar circumstances and background
Goal of the National institute of nursing research?
Promote and improve the health of individuals, families, communities and population
Do good
Promote welfare of others
Legal Issues
Protect the public, provide safe care, maintain currency of practice, adhere to practice acts, understand legal requirements of informed consent, advance health care directives, Health Insurance Portability and Accountability Act. HIPPA
nurse role
Protect, promote, and optimize our patients' health Prevent illness and injury Alleviate suffering through the diagnosis and treatment of human responses Advocate for the care of our patients To provide care and comfort and to emphasize health promotion and illness prevention
National standards and safeguards
Protecting individual rights. 1. Health plan (insurance provider; their regulations) 2. Health care clearing houses: billing agency 3. Health care provider: RN, Doctor, Physician
Teaching method
Psychomotor: demonstration, practice, return demonstration, independent projects, games
Administrative Law
Refers to rules, regulations and decision of administrative bodies, spells out specifics of a statutory law; i.e.: State board of nursing authorized by the Nurse Practice Act to promulgate specific regulations
Delayed ejaculation 8%
Repeated inability to ejaculate or by a very delayed ejaculation after normal sexual activity with a partner - Biological causes: low testosterone, neurological diseases, medications - Psychological cause: performance anxiety
Patient-Centered Care
Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs. Examples: Involve family and friends in care. Elicit patient values and preferences. Provide care with respect for diversity of the human experience.
Interpretation
Recognize, understand, and explain the meaning of a situation
Maintain Consistency
Regular work and steady application and self pacing equals success, avoid procrastination by breaking large tasks into smaller ones
Define tertiary prevention.
Rehabilitation, regaining independence. You have the problem, now help fix it.
Beneficence/Non-maleficence
Relating in patients in ways that will promote health, relieve unnecessary pain and suffering and prolong life; do no harm
Cultural Differences in Sexuality
Relatively little is known about racial & other cultural differences in sexuality -Sex therapists &sex researchers have only recently begun to attend systematically to the importance of culture and race
1. Unilateral dependence
Reliant on external authority; limited questioning or critical analysis
Paraphilic Disorders
Repeated & intense sexual urges & fantasies in response to socially inappropriate objects or situations (ex: non-human, children, non-consenting adults, experience of suffering or humiliation)
low staff ratios
Research shows that _______ ________ _______ is linked to poorer patient outcomes, lengthened hospital stays, and increased chance of patient death
Qualitative research
Research that is non-experimental and describes phenomenon.
Social Worker: connect with _____________. a. resources b. society c. employers d. lost family members.
Resources
"Shared"
Respect and use the preferences of the patient and the expertise and judgment of the clinician
false imprisonment
Restraining a person, with or without force, against that person's wishes.
Express contract
Result of the parties in a contract discussing & agreeing on specific terms & conditions
5 R's
Right Task Right Circumstance Right Person Right Instructions Right Supervision and Evaluation
Who created the Nurses' Ethical Reasoning Skill Model?
Roseanne M. Fairchild PhD RN CNE NE-BC
Nursing process evaluation
See through the patient's eyes. Have the patient's learning needs been met? Evaluate a patient's learning by observing performance of expected learning behaviors under desired conditions. Discontinue, adjust, or amend the plan. Patient outcomes: Legal responsibility Documentation
Nursing process:implentating
Select appropriate instructional methods: Group instruction One-on-one discussion Preparatory instruction Demonstration Analogy Role playing Simulation
Nursing Model Self Care Model for Nursing -Dorothea Orem
Self-care activities are what people do on their own behalf to maintain health and well-being; the goal of nursing is to help clients meet their own therapeutic self-care demands Theory of Self Care Theory of Self Care Deficit Theory of Nursing Systems
Nurse practice act
Sets education qualifications and licensure requirements Determines legal titles and abbreviations nurses may use Provides disciplinary action
Orgasm phase of the sexual response cycle
Sexual pleasure peaks and sexual tension is released as the musclesin the pelvic region contract rhythmically •For men: semen is ejaculated •For women: the outer third of the vaginal walls contract •Three disorders of this phase: -Premature ejaculation -Delayed ejaculation -Female orgasmic disorder
3 actions that would violate patient confidentiality
Sharing medical records, giving unauthorized personal permission to see medical records, & giving out their condition.
Nursing Theory Human Becoming -Rosemarie Parse
She created a new way to look at man, health, environment and nursing. Health and meaning are co-created by indivisible human and their environment; nursing involves having patients share views of meaning goal of nursing focuses on the quality of life from the client's perspective. decision-making should be from the client not the nurse She talks about rhythmicity, phenomena and transcendence in the person's life.
Abandonment and Assignment Issues
Short staffing Legal problems occur if inadequate number of nurses will provide care. Floating Based on census load and patient acuities Physician's orders Nurses follow orders unless they believe an order is given in error or is harmful
starvation study of the 1940s
Simple withholding of food can lead to a host of psychiatric problems o Eating as an intervention - reduced anxiety
Types of Assertive Responses
Simple: "I think" Empathetic: "I realize you are tired but..." Confrontive: "You said you would walk George, but you did not"
Who wrote "Introduction to Nursing: An Adaptation Model"
Sister Callista Roy
Situation Type
Situation specific
Henderson's Basic Needs
Sleep, water, communicate emotions, worship, play, encourage independence
The ________ system in King's model presents concepts that consider social contacts such as those at school, work or in social settings
Social
self-regulating
The ethical code of a profession provides internal control for the profession and censure of members who act unethically, this is...
SSRIs (serotonin-enhancing antidepressant drugs)
Some use this as a specific technique for Premature Ejaculation -Often reduce sexual arousal or orgasm = may be helpful in delaying premature ejaculation •Many studies have reported positive results with this approach
Data security
Someone hacking computers with medical records on them.
Emancipated minor
Someone under the age of 18 who is financially independent, married, or in the military.
Agent
Someone who has the authority to represent another person
Which war set the stage for the Army Nurse Corp?
Spanish- American War of 1898
Desire
Stage 1
Stages a patient goes through when diagnosed with a severe or chronic illness.
Stage 1- Disbelief and denial Stage 2- Irritability and anger Stage 3- Attempting to gain control Stage 4- Depression and Despair Stage 5- Acceptance and participation
Cohen's Model of Student Socialization
Stage 1: Unilateral dependence- inexperienced, lack knowledge, don't analyze or ask question Stage 2: Negativity/Independence- begin to question authorities, think critically, demand difficult patient situations Stage 3: Dependence/Mutuality- Students' more reasoned evaluation of others' ideas, accepting and rejecting ideas Stage 4: Interdependence- needs for independence and sharing come together, seek out learning experiences, work well with others
Stages of Nursing's Political Development (Cohen et al, 1996)
Stage One: Buy-In Stage Two: Self-Interest Stage Three: Political Sophistication Stage Four: Leading the Way
Protocols
Standard methods of performing tasks
Outcome Standard
Standard that focuses on the patient-client-recipient of services; Focus on the end products of quality care; i.e.: - reflect the effectiveness and results rather than the process of giving care - the patient will have a temp less than 100 degrees F within 24 hours
Administrative simplification
Standardizing the codes and formats used for interchange of medical data
Specialty Standard
Standards developed to guide the practice and education of nurses who perform a specialized role or advanced practice role; i.e.: Standards for each of the 28 nursing specialties, NP's, CRNA's
Acknowledgement
States you've seen privacy notice, if you refuse to sign, they can still treat you.
Steps of Research:
Steps of Research: 1. Identify a research problem 2. Review of Literature 3. Formulation of the research question or hypothesis 4. Design of the study 5. Implementation 6. Drawing conclusions based on findings 7. Discussion of implications 8. Dissemination of findings
Lifelong type
Struggle with sexual dysfunction their whole lives
Cohen's Model of Socialization
Students must experience each stage in sequence to feel comfortable in the professional role
conventional level
Studies show the few nurses practice above the ___________ _________of ethical reasoning
Key Components of Service Learning
Sufficient thought and preparation, action, reflection and analysis about the experience
Skills that provide comfort
Sympathy: I'm sorry, truly feel sad for patient Compassion: expressing and asking emotional response Reflexive Reassurance: AVOID "Your gonna be okay", only use when you know 100% gonna be okay
The goal of ___________ nursing involved planning nursing care based on specific knowledge that is culturally defined, classified and tested
Transcultural
What type of thinking does the Nurses' Ethical Reasoning Skill Model use?
Systems thinking *Reflect on experiences from a holistic, values-based, knowledge-drives stance *Reason within ourselves about our reflection and review competing values *Finally act on our conclusion
False - a student does NOT practice under his or her instructor's license
T/F: A student nurse practices under his or her instructor's license.
Meaningful Reading
Take time to complete reading will reduce time required to review for exams Mistakes include, reading to fast, reading immediately, reading passively, underlining too much/little
What does NINR do?
The National institute of Nursing research advances nursing science by supporting research on the science of health, which promotes the focuses on the promotion of health and quality of life.
T/F A PhD nurse gains knowledge & skills to apply analytical approaches to the discovery & application of knowledge in nursing & Health Care.
TRUE
T/F Around WWII: There was a growing interest in social & organizational structure of Health Care.
TRUE
True or False: Nursing decision affect patients
TRUE
Preserve life
Take all possible means to preserve life. Dilemmas: organ transplants, stem cell, rationing care and resources
Patient education
Teaching An interactive process that promotes learning Learning The purposeful acquisition of knowledge, skills, behaviors, and attitudes
Coordinator of Interdisciplinary Health Care Team
Team: nurse, physician, pharmacist, dietitian, physical therapist, speech therapist, occupational therapist Ensure that the client and his/her needs are the focus of the team
deposition and how it can be used
Testimony under oath, sworn statement. Purpose: assist opposing counsel in preparing for the court case.
What is the future recommended level of education for an APRN? What does the acronym "LACE" stand for with regards to the legal practice of APRNs?
The AACN has recommended that the DNP be the entry level degree for advanced practice. LACE stands for licensure, accreditation, certification, and education.
The national voice for America's baccalaureate and higher-degree nursing education programs. ____________________ educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's and graduate degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate education, research, and practice in nursing a. American Nurses Association (ANA) b. Sigma Theta Tau c. The American Association of Colleges of Nursing (AACN) d. National Student Nurses' Association
The American Association of Colleges of Nursing (AACN
Legal control is directed by:
The Nurse Practice Act It tells us what we can and cant do
nonmaleficence
The duty to do no harm. Ex: Giving a patient pain medication before dressing a painful wound.
Direct cause
The breach of duty, actually caused an injury
What is the goal of evidence base practice?
The goal is to use the best available research findings to make clinical decisions that are most effective and beneficial for patients.
Nursing Theory Goal-Attainment Imogene King
The goal of nursing is to use communication to help the client reestablish positive adaptation to the environment. her theory into health concerns in three systems: social, personal, interpersonal Theory of Goal Attainment stated: Behavior>return behavior>disturbance>set goal>agree on goal>help attain goal
• Discuss the need for quality improvement and strategies to improve care.
The healthcare system is fragmented and in need of improvement. Strategies: -Identify errors & hazards -Implement basic safety design principles -Measure quality of care -Design and test interventions
provision 8 of the ANA Code of Ethics
The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. (Health needs and concerns, Responsibilities to the public)
provision 4 of the ANA Code of Ethics
The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care. (Acceptance of accountability and responsibility, Accountability for nursing judgment and action, Responsibility for nursing judgment and action, Delegation of nursing activities)
provision 5 of the ANA Code of Ethics
The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. (Moral self-respect, Professional growth and maintenance of competence, Wholeness of character, Preservation of integrity)
provision 6 of the ANA Code of Ethics
The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. (Influence of the environment on moral virtues and values, Influence of the environment on ethical obligations, Responsibility for the health care environment)
provision 7 of the ANA Code of Ethics
The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. (Advancing the profession through active involvement in nursing and in health care policy, Advancing the profession by developing, maintaining, and implementing professional standards in clinical, administrative, and educational practice, Advancing the profession through knowledge development, dissemination, and application to practice)
the relationship between the state Nurse Practice Act and the requirements for nursing licensure and certification.
The nurse practice act for each state establishes the requirements for licensure- some states have different requirements than others
provision 1 of the ANA Code of Ethics
The nurse practices with compassion and respect for the dignity, worth, and uniqueness of every individual, unrestricted by social or economic status, personal attributes, or the nature of health problems
provision 3 of the ANA Code of Ethics
The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. (Privacy, Confidentiality, Protection of participants in research, Standards and review mechanisms, Acting on questionable practice, Addressing impaired practice)
Advocate
The nurse protects the client by preventing physical and/or chemical injury. o In the role, the nurse assists clients in expressing their rights whenever necessary. o The nurse also works to preserve clients' legal and human rights in times of health and illness, and during the process of dying.
provision 2 of the ANA Code of Ethics
The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
Conceptual framework that enables the student or practicing nurse to think systematically and process pertinent information about the patient." NANDA International "Facilitate the development, refinement, dissemination and use of standardized nursing diagnostic terminology" with a goal to, "improve the healthcare of all people."
The nursing process
Living will
The part of an advance directive that outlines the individuals wishes regarding the type and extent of medical care to be given.
__________ is an orderly systematic way of thinking and solving problems
The scientific method
What three interrelated theories were discussed in Orem's "Nursing: Concepts of Practice"
Theory of self care, Theory of Self - care deficet, Theory of nursing system
Specific techniques for Delayed ejaculation
Therapies for this disorder include techniques to REDUCE performance anxiety & increase stimulation - For Physical Cause = treatment may include a drug to increase arousal of the sympathetic nervous system
Importance of Evidence Based Practice
There is a bridge between nursing research and EBP, foundation for practice, link between research and practice, nursing process, and professionalization of nursing (own body of knowledge based on scientific principles)
confidentiality; privacy
There is a difference between __________ ( more to do with information) and ____________ (more to do with the person)
culturally diverse
There is a strong connection between a ___________ ___________ nursing workforce and the ability to provide quality, culturally competent patient care
Intentional tort
There must be a volitional or willful act by the defendant. The defendant must intend to bring about the consequences or appear to have intended to bring about the consequences. There must be causation: Cause and Effect relationship.
Informal Socialization
Things that are coincidental. ex: learning a new role by observing how others behave. WATCHING.
• Examine how the Institute of Medicine reports on quality care have had an impact on nursing and healthcare delivery
To Err Is Human: -Serious safety problems in hospitals -Accreditation has not been enough What happens when there are errors? -complications may occur and increase costs -opportunity costs increase -decrease in patient trust Patients started to ask more questions and get more involved with their care.
Propose of ethics
To help people deal with difficult & complex problems that lack easy answers.
purpose of risk management
To identify, analyze, and treat potential hazards in a practice setting before anyone is harmed or disabled. To develop and evaluate policies and procedures that provide guidelines for the institution and direct practice. To make and carry out decisions that will limit unintended adverse events for staff and clients and minimize financial loss to the organization
Nurse goals
To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice
Communicating
To other health care provider, To different departments, Patient advocate, Self advocate
Goal of nursing research?
To promote and improve the health of individuals, families, communities and populations.
Beneficience
To promote goodness, kindness, and charity, To abstain from injuring others and to help others further their well-being by removing them from harm
Orgasms during intercourse not mandatory for normal sexual functioning
True
TRUE/ FALSE active listeners have good eye contact
True
TRUE/ FALSE active listeners use nonverbal cues such as body language and touch
True
Profession
Type of occupation that meets certain criteria that raise is to a level above an occupation, requires high level of commitment
Which branch ensures order, protects individuals, promotes general wellfare and resolves disputes?
US consitution
Sentinel Event
Unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Ex: •An unanticipated death of a full term infant •An infant abduction or discharge to the wrong family •Rape •Suicide •Hemolytic transfusion reaction •Wrong site or wrong patient surgery
Nursing Theory The Science of Unitary Human Beings Theory -Martha Rogers
Unitary human beings are irreducible, four-dimensional, negentropic energy fields . fields have no boundaries, are open, have patterns and the patterns change.purpose of nursing is to help all people achieve maximum well being.
Invasion of privacy
Unreasonably intrudes on the client's private affairs
Quality Improvement
Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Examples: Use tools such as flow charts and diagrams to make process of care explicit. Appreciate how unwanted variation in outcomes affects care. Identify gaps between local and best practices.
Informatics
Use information and technology to communicate, manage knowledge, mitigate error, and support decision-making. Examples: Navigate an electronic health record. Protect confidentiality of protected health information in electronic health records.
Critical Thinking and Judgment
Used when analyzing client issues and problems. Thinking skills include interpretation, analysis, evaluation, inference, explanation. These skills facilitate critical analysis of the issue and assist you to determine the most appropriate action to take
Ethical theories: Principalism
Uses key principles in ethics to solve ethical dilemmas
Sexual Sadism Disorder
Usually male - repeatedly aroused by physical or psychological suffering of another individual *Arousal expressed through fantasies, urges, behaviors)
A nurse is on duty in the emergency room when the nurse is notified that a school bus has been struck by a train. Immediately the nurse reports to the triage area and begins the task of determining the severity of injuries, so that the most critical patients receive care first. Which ethical theory is the nurse putting into action?
Utilitarianism
Validity vs Reliability
V- does it measure what its suppose to measure (BP) R- reliable or not
Attitudes, ideals, or beliefs that an individual or group holds and uses to guide behavior
Values
Barriers to Professionalism
Variability in education preparation Differentiation of Practice: to utilize Nursing skills efficently Gender issues- men "power" Historical events- nurses had to serve/obey doctor External conflicts- hospital politics Internal conflicts- between the nurses ourselves Level of Autonomy and independence of practice
Levels of Communication
Verbal, Nonverbal, and Congruency (verbal and nonverbal messages match)
Which philosopher defined nursing and specified the role of the nurse in relation to the patient?
Virginia Henderson
Which philosopher stated "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge"
Virginia Henderson
Knowledge, Skills, and Attitude
What is KSA?
Quality and Safety Education in Nursing
What is QSEN?
Behavior
What is an expression of our values?
Understanding our own values
What is central to the study of ethics?
Nurse Practice Act
What is the most important law affecting my practice as a nurse?
advance and advocate for the patient
What is the nurse's responsibility in JCAHO's National Patient Safety Goals?
Set standards for entry into practice, Define scope of practice, and Allows for disciplinary action
What is the purpose of licensure?
Which philosopher founded the Center for Human Caring at the University of Colorado?
Watson
Standard 3: Priorities and Actions for Nursing Care (planning)
What Standard is this: The plan for nursing care must include individualized nursing actions to achieve the established outcomes.
I'm not sure I understand, Give an example of, What is the most important thing about
What are some clarification techniques?
Autonomy, Beneficence/Non-Maleficence, Veracity, Confidentiality, Fidelity, Justice
What are some ethical principles in nursing?
Gunshot, Child abuse, Infectious disease
What are some exceptions to the legal standard of confidentiality?
End poverty and hunger, Universal education, Gender equality, Child health, Maternal health, Combat HIV/AIDS, malaria, and other diseases, Environmental sustainability, Global partnership
What are the 8 millennium goals?
Modeling, Moralizing, Reward and Punishment, Laissez-Faire, Responsible Choice
What are the five modes of value transmission?
• Limit or restrict a license • Deny licensure • Suspend a license probate a license • Revoke a license
What are the fours way a licensee may be disciplined?
• Good moral character • Completed nursing education program approved by the board • Passes an examination NCLEX
What are the qualifications for licensure?
Ethics Education Evidence-Based Practice and Research Quality of Practice Communication Leadership Collaboration Professional Practice Evaluation Resource Utilization Environmental Health
What are the standards of professional Performance?
Assess the situation, Identify the ethical dilemma, Plan, Implement the Decision, Evaluate,
What are the steps in ethical decision making for nurses?
Capacity, decision is voluntary, Patient has essential information
What are the three criterium for the autonomy of a patient?
Choosing, Prizing, and Acting
What are the three processes of valuing?
"The registered nurse integrates evidence and research findings into practice."
What do the standards of professional performance say about Evidence-Based Practice and research?
"The registered nurse demonstrates leadership in the professional practice setting and the profession."
What do the standards of professional performance say about Leadership?
"The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations."
What do the standards of professional performance say about Professional Practice Evaluation?
"The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible."
What do the standards of professional performance say about Resource Utilization?
"The registered nurse attains knowledge and competence that reflects current nursing practice."
What do the standards of professional performance say about education?
"The registered nurse practices in an environmentally safe and healthy manner."
What do the standards of professional performance say about environmental health?
Person/Individual
What do you believe about the patient? Unique, different needs, different cultures, freedom of choice
Nursing's Social Policy Statement (ANA, 2010)
What document came out stating quality health care as a human right, nursing's professional interest mud the perceived as serving the public
Joint Commission on the Accreditation of Hospitals
What does JCAHO stand for?
Standard 5: Evaluation
What standard is this: 1. Evaluation is systematic and ongoing. 2. Current data about the individual are used to measure progress toward established goals. 3. Nursing actions are analyzed for their effectiveness in achievement of established goals. 4. The individual, family, and other significant health care personnel participate in the evaluation of established goals. 5. The individual's response is compared with observable outcomes which are specified in the established goals. 6. The individual's responses to interventions are documented. 7. Determination is made of the long term effects of nursing care on the individual
Standard 4: Implementation
What standard is this: 1. Nursing actions are consistent with the plan for nursing care. 2. Interventions are implemented in a safe and appropriate manner. 3. Nursing actions are documented by a. written records b. observation of nursing performance: PATIENT SAFETY HAS TO BE A PRIORITY!!
Standard 2: Analysis of Health Status Data
What standard is this: 1.The individual's health status is compared to the norm to determine if there is a deviation and the degree and direction of deviation. 2. Nursing diagnoses are documented in a manner that facilitates the determination of expected outcomes and plan of care. 3. Short and long term goals are mutually set with the individual and pertinent others.
Standard 6: Reassessment and Modification
What standard is this: The planning for nursing care is a continuous process of reassessment and modification, according to the following criteria.
Define performed role.
What the nurse actually does. Environment impacts this.
Define ideal role.
What the student is generally presented with. Society's expectations of what a nurse is. Not always realistic.
Caring for self, Caring for others, Caring based on interconnectedness
What were Gilligan's stages of moral development found in her study of women in 1977?
Pre-conventional, conventional, post-conventional
What were Kohlberg's stages of moral development found in his study of men in 1969?
deal with other people
What you believe to be important inevitably determines the methods you use to...
If it's not documented, it didn't happen
What's the rule about documentation?
situations may constitute false imprisonment
When a patient is threatened or his or her clothes are taken away to prevent him or her from leaving
Breach of contract
When one of the parties in a contract fails to fulfill its part of the agreement
Implied contract
When the actions of the parties create a contract with out it being detailed in a written format.
Moral Distress
When the nurse knows the ethically appropriate action to take, but is unable to act upon it
WHO
Who has placed the 8 millennium goals for 2015?
ANA
Who wrote and published the code of ethics?
to safeguard the public
Why do standards exist?
Sex affects blood alcohol content, which gender can have more & why?
Women become more intoxicated than men o Women have less alcohol dehydrogenase, an enzyme in the stomach that metabolizes alcohol before it enters the blood
Collaboration in Health Care
Working with other health care team members, recognizing their unique knowledge and skills, to improve patient safety and outcomes Sharing knowledge and authority
Health
World Health Organization: WHO- state of complete physical, mental, and social well-being but not the absence of disease -takes on wholistic view, dynamic and changing -involves perception, on a continueum line
Advance directive
Written documents Detail patients wishes regarding health care decisions. Consists of living will & the durable power of attorney.
What percentage of the US says that the current health care system fails to meet their needs: a. 10% b. 26% c. 43$ d. 55%
d. 55%
The two types of credentials are a. education b. experience c. continuing ed d. practice
a & d
Ethics
a branch of philosophy that examines behavior to determine what constitutes good, bad, right and wrong behavior and provide guidance for action
Proximate cause
a cause that is legally sufficient to result in liability.
Dissatisfaction or Storming
a chaotic vying for leadership, members are focused on control issues, members test each other and can attack others, don't see themselves as part of a team, may argue
Emancipation
a child is a minor, and therefore under the control of his or her parents/guardian until her or she attains the age of majority (18 yrs) at which point he or she is an adult. In special circumstances, a minor can be freed from control by his or her guardian and given rights of an adult before turning 18. In most states the three circumstances under which a minor becomes emancipated are (1) enlisting in the military (which requires parent/guardian consent), (2) marrying (requires parent/ guardian consent), or (3) obtaining a court order from a judge (parent or guardian consent not required). A minor can also petition the court for this status if financial independence can be proven and the parents or guardian agree. An emancipated minor is legally able to do everything an adult can do, with the exception of actions that are specifically prohibited if one has not reached the age of 18. From a healthcare perspective, emancipated minors can sue and be sued in their own name, enter into contracts, and seek or decline medical care.
Modeling
a child wishes to be like a parent; Ex. Watching parent and doing like the parent
CAM
a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.
Occupation
a group of jobs that are similar in type of work and that are usually found throughout an industry or work environment "low level of commitment"
Expert Witness
a person within specific expertise and knowledge who can provide testimony to prove the standard of care. A nurse may serve as an expert witness for nursing care but not for medical care issues. Typically, the nurse is also a specialist in the specific area of care being addressed in the legal case
Respondent superior
a principal (employer) responsible for the actions of his, her, or its agent (employee) in the course of employment. This doctrine allows someone to sue the employee who is accused of making an error that resulted in harm. The patient also may sue the employer, the hospital, because the employer is responsible for supervising the staff member.
System
a set of intrarelated parts that come together to form a whole (patients, family)
gender dysphoria
a sexual disorder included by DSM-5 that is described as a pattern in which people feel that they have been born to the wrong sex
culture
a shared system of beliefs, values and behavioral expectations that provides social structure for daily living; develops over time and is difficult to change
how professional nursing values are acquired.
a. Acquired during socialization into nursing from code of ethics, nursing experiences, teachers, and peers. b. Traditions and cultural, ethnic, and religious groups
The _______________________________ is the only full-service professional organization representing the interests of the nation's 3.1 million registered nurses through its constituent member nurses associations, its organizational affiliates, and its workforce advocacy affiliate, the Center for American Nurses. The _________ advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public. a. American Nurses Association (ANA) b. Sigma Theta Tau c. The American Association of Colleges of Nursing (AACN) d. National Student Nurses' Association
a. Amerian Nurses Association (ANA)
In 2008, our medical social safety net cost each citizen $7861, in 2008, it will cost us each ______. a. $ 7861 b. $130 c. $12,320 d. nothing, the government pays for it.
c. $12,320
Name the least likely trend in nursing: a. Most hospitals will get rid of critical care units. b. There will be an increased need to make complex, independent nursing care decisions. c. Ethical issues will increase. d. Development and application of nursing as a practice science, thus the DNP degree. e. Entrepreneurial opportunities will increase for nurses.
a. Most hospitals will get rid of critical care units
This is held by a group in a society which allows administration of some or all of public resources, including labor, and wealth. a. Political Power b. self esteem c. social capital d. hostages
a. Political Power
Which of the following does not follow from a Masters in Nursing: a. intense research oriented program of study b. nurse educator c. nurse administration d. advanced practitioner
a. intense research oriented program of study
The nurse participates in the advancement of the profession through contributions to practice, education, administration, and___________________________. a. knowledge development b. good humor c. attendance at conventions d. awesomeness.
a. knowledge development
An act of omission of care which an ordinary prudent person would have done under the given circumstances; act of commission where something is done which the ordinary prudent person would not have done under the given circumstances. a. negligence b. harassment c. torture d. ignorance
a. negligence
Whose role is it to diagnose and treat the human response to actual or potential health problems/needs? a. nurse b. Physician c. aide d. parents
a. nurse
The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide _________________. a. optimum patient care. b. low cost to the provider c. short hospital stays d. good times for all.
a. optimum patient care
The physiological dimension of man, Actions aimed primarily at supporting, stabilizing or correcting the problems are the foci of a. physicians b. therapists c. nurses d. counselors
a. physicians
Medicare and Medicaid costs are: a. rising b. shrinking c. staying the same d. going away due to new health care bill.
a. rising
Around WWII, major political, social, and ________________ changes occurred that affected medicine and nursing. a. technological b. religious c. historical d. economic
a. technological
match the technology with the era: a. 1800-1900 b. 1900-2000. 1. stethoscope 2. ventilator 3. defibrilator 4. sphigmometer 5. cardiac catheter 6. artificial organs
a: 1,4 b: 2,3,5,6
Self Regulation
ability to control emotion, cope with change
Emotional Awareness
ability to identify mood changes, knowing the effect you have on people
Social Skills
ability to listen, handle conflict
Power Approach
ability to make things happen Independence-how much independence does a profession have? Control-how much power does the profession control? Ex- money, political power
Empathy
ability to tune into someone elses needs
coronary thrombosis
abnormal condition of a clot in a blood vessel of the heart
illness
abnormal processes in which any aspect of the person's functioning is altered (in comparison to the previous condition of health)
Philosophies based on Beliefs
acceptance of something that is correct or true based on experiences or religion
Acting
acting on the choice with consistency, incorporation the choice into behavior
Breach of Duty
action does not meet the standard of care may involve giving improper care assessment error didn't recognize symptoms or change in judgment planning error
Harm
actual harm, injury or exacerbation of current condition occured
cardiac tamponade
acute compression of the heart caused by fluid accumulation in the pericardial cavity
Security
administrative procedures must be in place for guarding data, confidentiality, integrity, and access
ARNP
advanced registered nurse practitioner
Dorthea Dix
advocate for mentally ill
The most important hierarchy of needs is _____
air
excessive sexuality
aka hypersexuality or sexual addiction Being more paid attention to by therapists
Probation
allows the licensee to practice as an RN under certain restrictions for a set period of time
A nursing diagnosis is needed when there is a ________ related to pain and swelling or resulting in a lack of sleep
alteration of comfort
cultural blindness
completely ignore that they are apart of another culture
crime
an act committed in violation of public law (felony, manslaughter, misdemeanor)
Malpractice
an act or continuing conduct of a professional that does not meet the standard of professional competence and results in provable damages to his or her patient.
Nursing is both _________________. a. competitive & fulfilling b. an art and science c. dangerous & fun d. mysterious and misunderstood.
an art and science
alcohol dehydrogenase
an enzyme in the stomach that metabolizes alcohol before it enters the blood - women have less of this
rheumatic fever
an inflammatory disease usually occurring in children and often following an upper respiratory streptococcal infection
cerebral aneurysm
aneurysm in the cerebrum
managed care
any system of insurers and health providers that coordinates fees and payments in an attempt to lower the cost of medical care
arrhythmia
any variation from the normal heart rhythm
General Leads
anything that encourages the client to verbalize, head nod, "I wanna hear more."
ANA defines nursing
as the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations
During the ______ stage of the nursing process the nurse gathers the patient's vital signs, height, weight, history and any other tests such as blood tests
assessment
________ is the step within the nursing process with involves data collection and validation
assessment
Moralizing
authority figure holds the standard for right and wrong; Ex. Parents telling you that you have to do things their way
A ______________ is a more specific organization of nursing phenomena than a philosophy
conceptual model / framework
Which of these should you omit if you wanted to preventing legal problems whilst working as a nurse? a. Follow the standards of care and all policies b. Chart when convenient c. Document facts not judgments d. Chart normal and abnormal situations e. Assess and monitor patient
b. Chart when convenient
The emphasis on health care efficiency and effectiveness of meeting the patient's goal (team work) a. Delegated b. Interdependent/collaborative c. Independent
b. Interdependent/collaborative
Which of these is an example of planning: a. nursing action initiated and completed to achieve the patient expected outcomes b. Nursing behavior in which the patient-centered goals and expected outcomes are selected c. any action the nurse takes to help the patient move the present health state to the expected outcome d. Measure the patient's response to the nursing actions and patient's progress towards achieving the expected outcome
b. Nursing behavior in which the patient-centered goals and expected outcomes are selected
The Nurse Practice Act of the State of Arkansas is the act which provides for the regulation of the practice of nursing; provides for a ______________________, and defines the power and duties of the Board. a. licensure process b. State Board of Nursing c. paid vacation for all nurses d. union
b. State Board of Nursing
A Credential System is/does all but one of the following: a. letter or certificate given to a person b. gives permission to go outside of scope of practice c. right of confidence d. exercise a position of authority
b. gives permission to go outside of scope of practice
Image in any discipline is first dependent upon the ____________________. a. eye of the beholder b. initial impression c. mood d. current fads
b. initial impression
Which of these do you NOT have to do in order to be Licensed by the Sate Board of Nursing: a. degree completion b. perfect score on NCLEX c. complete application d. pass background/drug check
b. perfect score on NCLEX
The goal of ______________ is to cure disease, preserve life & ward off illness, pain and death a. Nurse b. Physician c. Therapist d. Priest
b. physician
These all are other solutions beyond attire for improving the image of nursing except for: a. seeking the optimal standard of care delivery b. positive thought practices c. supporting and participating in research activities d. becoming a voice for needed social change e. developing media relationships
b. positive thought practices
The purpose of the act is to safeguard life and health, .....submit evidence that he or she is qualified to ________ and shall be _________ a. learn, matriculated b. practice, licensed c. teach, hired d. practice, hired.
b. practice, licensed
The nurse_____________, ________________, and strives to protect the health, safety, and rights of the patient. a. understands, maintains b. promotes, advocates for c. obstructs, challenges d. diagnoses, treats
b. promotes, advocates fo
Other Essentials of Magnets include: a. support of education b. reduced staffing to ensure higher pay. c. concern for the patient is paramount d. cultural overview
b. reduced staffing to ensure higher pay.
If you are officially recorded you are: a. licensed b. registered c. official d. in trouble
b. registered
ArNA supports workplace advocacy program- facilitates the professional nurse in creating a _________, ___________________ work environment in which to deliver safe, quality patient care. a. effective, fruitful b. safe, uncompromised c. fun, exciting d. fast-paced, collaboratative
b. safe, uncompromised
The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of _____________ or ______________ ________________, personal attributes, or the nature of health problems. a. ethnicity, national origin b. social, economic status c. gender, sexual orientation d. age, educational level
b. social, economic status
Whole medical systems
based on different philosophies and life systems
Caring for others
based on responsibility
Caring based on interconnectedness
based on the understanding of the interconnectedness of self and others, care becomes the self chosen principle of judgment
Tertiary prevention
begins when the patient's system becomes more stable and recovers.
Suspension of License
board has ordered the licensee not to practice as a RN for a set or indefinite period of time. Suspensions may be imposed in disciplinary actions, prior to a probation term, or may be imposed as the result of a violation of probation
Revocation of License
board revoked the license and the licensee no longer has the right to practice as an RN or use the title
A "conceptual framework that enables the student or practicing nurse to think systematically and process pertinent information about the patient" is an example of what? A. Critical thinking in nursing B. Evidence based practice C. The nursing process D. The research process
c- the nursing process
In 2008, what percentage of the Gross National Product was due to health care ? a. 16.2% b. 33.3 % c. 40.8% d. 55.1%
c. 16.2%
Nurses and MD's started working more as collaborators and team members in which historical period? a. pre-1900 b. 1900-1970 c. 1970-present d. HA! Hasn't happened yet!
c. 1970-present
Long term stay hospitals are where patients stay for longer than a. 24 hours b. 3 days c. 30 days d. 3 months.
c. 30 days
This group, founded in 1887 as the Alumnae Association, adopted it's new name in 1911, publishes the Standards of Practice & Code of Ethics, and is the main lobbying group for nurse's. a. National Student Nursing Association b. National League for Nursing c. American Nurse's Association d. American Association of Colleges of Nursing
c. American Nurse's Association
The client who charges that he/she did not receive competent care must prove all of the following except: a. Legal Duty b. Breach of duty c. Call of Duty d. Injury has occurred e. exceeded license f. act of commission/ omission g. Approximate or direct cause
c. Call of Duty
This nurse was from Victorian England and worked duing the Crimean war to improve sanitation, started nursing schools associated with hospitals and apprenticeship, and did not believe in germ-theory. a. Clara Barton b. Dorothea Dix c. Florence Nightingale d. Lavinia Dock e. M. Adelaide Nutting
c. Florence Nightingale
Autonomous nursing action based on scientific rationale that is executed to benefit the patient in relation to the nursing diagnosis and patient centered goals a. Delegated b. Interdependent/collaborative c. Independent
c. Independent
Which of the following is NOT a current trend in Nursing: a. The nursing shortage (long picture) b. Nurses are part an answer to health care cost and effectiveness. c. Most nursing care is still provided in the community, but more is moving to the hospitals. d. Nurses are a graying work force. e. Advanced practice nurses will be responsible for primary care. f. Entry into practice and titling are problems for the profession.
c. Most nursing care is still provided in the community, but more is moving to the hospitals.
During the Middle Period of Nursing in the US, this was the first doctor owned nursing school. a. Women's Hospital of Philadelphia b. Presbyterian Hospital (NYC) c. Nurse Society of Philadelphia d. Mt. Sinai
c. Nurse Society of Philadelphia
According to the RWJ Foundation, which of the following is NOT true about the future of nursing? a. Nurses should practice to the full extent of their education and training. b. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. c. Nurses should accept their current role with physicians and other health care professionals. d. Effective workforce planning and policy making require better data collection and information infrastructure
c. Nurses should accept their current role with physicians and other health care professionals.
Which of these can result in a Revocation of license: a. small med error b. traffic violations c. addiction to drugs d. glaring at puppies.
c. addiction to drugs
According to the Kellogg Foundation report from 2005, who is a more likely user of the health care system: a. a young man b. a middle aged woman c. an elderly woman d. a terminally ill elderly man
c. an elderly woman
This is used to formulate a nursing diagnosis: a. hunches b. preconceived notions c. data d. patient self diagnosis
c. data
The nursing process is all of the following except: a. a systematic comprehensive process b. based on the scientific method c. has four steps d. a communication device for the nursing team and medical team
c. has four steps (it has 5)
Credentials can be any of the following except: a. degree b. license c. honorary degrees d. certificate e. memberships in particular organizations.
c. honorary degrees
Modern Hospital- (18th c.) the first large ___________ began to flourish. a. Nurse's guildes b. epidemics c. hospitals d. nurse training programs.
c. hospitals
Legal condition whereby a person can be said to have given consent based upon a clear appreciation and understanding of the facts, implications, and future consequences of an action a. Permission b. implied consent c. informed consent d. Authorization
c. informed consent
_____________ appeared in the 19___'s as private duty nursing faded out. a. inpatient hospitals, 50's b. outpatient surgical centers , 70's c. intensive care units, 60's d. NICU's, 80's
c. intensive care units, 60's
This is the process by which a governmental agency grants "legal" permission to an individual to practice nursing a. registration b. testing c. licensing d. vetting
c. licensing
Which of the following did not follow WWII: a. Insurance plans b. Hill-Burton funds c. managed care d. medicare e. NIH
c. managed care
This role of a nurse ________________________, is the day to day operation of group work focusing on individuals, families and communities to achieve the desired patient outcomes a. caregiver b. teacher c. manager d. practitioner
c. manager
The __________ owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. a. doctor b. patient c. nurse d. unit secretary
c. nurse
The human response, which is the integration of the physical, psychological, socio-cultural, and spiritual dimensions of man is the major focus of: a. physician b. therapist c. nurse d. counselor
c. nurse
The nurse's primary commitment is to the_____________, whether an individual, family, group, or community. a. provider b. payer c. patient d. potential lawsuit plaintiffs
c. patient
Nurses involvement in _______________________ activities is a major step toward empowerment. a. blogging b. continuing ed c. policy making d. pirate
c. policy making
Which of these is not a valid criticism of our current health care system: a. too costly b. millions not insured c. technology makes no discernible difference to outcome. d. health care error e. ranked low in world health stats and disparity
c. technology makes no discernible difference to outcome.
Which one of these is a career? a. an activity through which an individual can earn money. It is a regular activity in exchange of payment. b. an activity through which an individual does not usually earn money. It brings enjoyment and opportunities for socialization. c. the pursuit of a lifelong ambition or the general course of progression towards lifelong goals. d. none of the above?
c. the pursuit of a lifelong ambition or the general course of progression towards lifelong goals.
Which is NOT a result of post WWII policy changes: a. medicare b. employer provided insurance c. universal health care d. welfare programs
c. universal health care
This form of ethics says that the end justifies the means; is concerned with the end product; and states that good is the greatest happiness for the most people. a. hedonism b. stoicism c. utilitarianism d. deontologism
c. utilitarianism
____________ of nursing provide organizational structure for critical thinking about the processes of nursing
conceptual models
A critical thinker comes to well reasoned _____ and ______
conclusions; slutions
All of these Factors will increase health care services (CDC) except: a. Increased supply (ambulatory surgery, assisted living b. Growing population c. yoga d. Growing elderly population e. New procedures and technology
c. yoga
All of these Factors will increase health care services (CDC) except: a. New diseases b. New drugs c. yogurt d. Changes in practice patterns e. Changes in consumer preferences and demand
c. yogurt
The therapeutic and significant contribution of nursing is accomplished through performance of the roles of ____________, manager and teacher of health care. a. caregiver b. therapist c. aide d. advocate
caregiver
Professional Roles of a nurse
caregiver advocate educator communicator manager
Watson's ________ guide nurses by specifying the meaning of the relationship of nurse and patient as human beings
caritas processes
battery
carrying out the threat of touching another person without his/her consent
CNM
certified nurse midwife- masters degree focuses on midwifery-pregnancy and delivery
All goals created during the planning stage of the nursing process should be _____ centered
client
The focus of the therapeutic communication process is on the _______
client
__________ interventions are activities that are performed either jointly with another health care professional or as a result of a joint decision
collaborative
Implementation normally includes ________ the action
communicating
_______ is a process by which information is exchanged between individuals through a common system of symbols, signs, and behaviors
communication
coarctation of the aorta
congenital cardiac condition characterized by a narrowing of the aorta
_________ communication occurs when the verbal and nonverbal aspects match and reinforce each other
congruent
medical staff
consists of a group of physicians, who may be employees of the health care organization or independent practitioners, must be granted privileges by board of trustees.
A __________ is a method for obtaining data during the assessment stage of the nursing process which occurs when the nurse discusses a patient's needs with health care workers and others who are directly involved in the care of the patient
consulsation
Within the communication process the _________ is the setting which an interaction occurs along with the mood, relationship between sender and receiver and other factors
context
During the evaluation stage of the nursing process, if goals are met you _________
continue
Under Peplau's theory there are 6 roles the nurse takes on:
counselor, resources, teacher, technical expert, surrogate, leader
A ________________ approach, known as the nursing process is used to meet health care needs. a. comprehensive b. holistic c. intuitive d. critical thinking
critical thinking
______ is the process of purposeful, self regulatory judgement
critical thinking
_________ is reasonable, reflective thinking that is focused on deciding what to believe or do
critical thinking
Which event and date is mismatched: a. 1940s -Hospitals had deplorable work conditions b. 1946-ANA focused on the general and economic welfare of its members c. 1974- The National Labor Relations Act as amended by the Taft-Hartley Act is the federal law governing labor relations in private business d. 2000 Center of American Nurse established
d. 2000 CAN established (2000- UAN, 2003-CAN)
Which of these is NOT a historical issue affecting power in nursing? a. For centuries, women discouraged from political participation b. Women not encouraged to enroll in college c. Physicians seen as the "Captain" of health care for clients d. Insurance industry changes. e. Since the 1970's, nurses are realizing their legitimate and expert power that can influence politicians
d. Insurance industry changes.
Which is matched incorrectly: a. Objective-Vital Signs b. Subjective primary-patient self report c. subjective secondary- info from family d. Objective secondary- lab reports
d. Objective secondary- lab reports
which of these is NOT one of the 6 rights of delegation? a. Right task b. Right person. c. Right time d. Right to refuse
d. Right to refuse
Which is NOT a prediction affecting Nursing- a. Equal access to health care is needed; health care reform was passed; a national health insurance will arise. b. Higher degrees (more knowledge) will be needed c. Scientific advancements in genetics and genomics d. Status quo in the demographics of patient populations e. New care technologies
d. Status quo in the demographics of patient populations (changes)
These "Failure to's" are the most common malpractice claims against nurses except for: a. follow standards of care b. use equipment appropriately c. communicate d. accurately anticipate consequences e. assess and monitor f. act as a patient advocate g. document and report
d. accurately anticipate consequences
Legal Duties of the Nurse: Duties to the employer: a. obey the rules b. report problems c. act as a reasonably competent nurse d. all of the above
d. all of the above
Political _____________ and _____________________ is the key to empowering nurses and building an effective health care system. a. power and persuasion b. capital and influence c. parties and conventions d. awareness and participation
d. awareness and participation
The act of assigning a task to another person while still maintaining accountability for the end result a. integrity b. passing the buck c. shirking d. delegation
d. delegation
Which step in the nursing process would prompt a re-assessment, new Ndx and/or interventions? a. assessment b. planning c. intervention/implementation d. evaluation
d. evaluation
Associate
degree offered as culmination of a 2 year program that includes some liberal arts and sciences curriculum but focuses more on nursing
Informed Consent must be given _____________ any surgical or MD performed procedure performed upon his/her person a. prior to b. 7-10 days before c. within 30 days after d. if deemed important by the doctor.
d. if deemed important by the doctor.
According to the Kellogg Foundation report from 2005, changes in technology do what to costs? a. dramatically lower them b. slighly lower them c. keep them close to the same d. increase them
d. increase them
Which of these does NOT reflect new research regarding a dress code for nursing? a. no long fingernails b. identifiable titles c. professional look and attitude d. increased personal expression e. hair back and off shoulders
d. increased personal expressio
Each of the following are solutions for improving our image except: a. establishing relationships- collaborating more with other health care disciplines b. taking care of oneself c. becoming a visible patient advocate d. massive marketing campaign
d. massive marketing campaign
What does the US get in return for it's highest spent per capita rating? a. top 10% in infant mortality b. highest life expectancy c. top 10% in quality of care d. none of the above?
d. none of the above
In the modern day nursing period between 1900-1970, which of these was NOT true? a. MD at the top of the medical delivery pyramid b. Nurses were characterized as passive c. Nurses were characterized as subservient d. nurses worked independent of MD's orders
d. nurses worked independent of MD's orders
According to the Kellogg Foundation report from 2005, which aspect of medical costs are increasing fastest? a. labor b. technology c. litigation d. prescription drugs
d. prescription drugs
The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of _________________ and consistent with the values of the profession through individual and collective action. a. affordable health care b. best practice methods c. evidenced based practice d. quality health care
d. quality health care
What's the main difference between a PhD and DNP? a. pay b. hours c. amount of schooling d. research vs. praxis
d. research vs. praxis
rheumatic heart disease
damage to the heart muscle or heart valves caused by one or more episodes of rheumatic fever
Analysis and Diagnosis
data is validated, compared to normal and a problem is identified clinical judgement about an actual/potential health problem that the nurse can treat
Criminal Laws
deals with actions against the safety and welfare of the public (homicide, manslaughter, theft)
myocardial infarction
death of a portion of the myocardial muscle caused by an interrupted blood supply (heart attack)
Clinical Judgement
decision made regarding a course of action based on a critical analysis of data when nursing knowledge is applied to a clinical situation. Help ensures safe care, high quality care, client centered care
multiple sclerosis (MS)
degenerative disease characterized by sclerotic patches along the brain and spinal cord.
PhD
doctoral degree (doctor of philosophy) - usually involved in research- may be called doctor
________ look at the disease aspect of a patient's care
doctors
A nursing diagnosis is needed when a patient is resulting in excessive ______
drainage
Which is the appropriate progression in health problems evolution? a. infectious disease → chronic illness, b. chronic illness → individual illnesses c. individual illnesses → epidemics d. epidemics → individual illnesses e. a & d
e. a&d
According to the ASBN, the Practice of professional nursing includes which of the folloing? a. the observation, care, and counsel of the ill, injured, or infirm b. the maintenance of health or prevention of illness of others c. the supervision and teaching of other personnel d. the delegation of certain nursing practices to other personnel as set forth in regulations established by the board e. all of the above.
e. all of the above.
Essentials of Magnets include: a. work with clinically competent nurses b. good nurse-physician relationship c. nurse autonomy & accountability d. control over nursing practice e. pay equity with doctors.
e. pay equity with doctors.
Florence Nightingale believed that health was related to patients' _______
environments
Reflects what actions an individual should take
ethics
During which stage of the nursing process do you assess the nursing care plan effectiveness?
evaluation (fifth)
The fifth stage of the nursing process is _________
evaulation
Resolution or Norming
eventual agreement of on goals and how group should operate, members should realize they must move toward consensus, members feel part of the team and value other types
External Factors Influencing socialization
experiences with the health care system, family, friends' values, and beliefs
Which of these is NOT a part of the nursing process? a. Assessment b. nursing diagnosis c. planning d. Intervention/Implementation e. evaluation f. getting Physician approval
f. getting Physician approval
Maintenance Roles
facilitate communication within the group -Standard setter: are things OK? point out rules -Encourager: sensitive to other's needs -Harmonizer: tries to decrease tension, reconciles differences -Compromiser:willing to be flexible with his or her ideas in the interest of the groups growth
If a patient states " I've got to get out of the hospital. They have found out I'm here and may come after me." and the nurse responds "No one will harm you here." the nurse has responded as if the patient's meaning was clear which is a common pitfall of communication _________
failure to clarify
Negligence
failure to exercise the care toward others that a reasonable or prudent person would under the circumstances.
syncope
fainting or sudden LOC caused by lack of flood supply to the cerebrum
Fidelity
faithfulness to the nurse patient contract; Keep promises to the patient; Trust is the cornerstone of the nurse patient relationship
Fidelity
faithfulness, honor commitments
If a patient says " I'm so afraid the biopsy will show cancer." and the nurse states "Don't worry. You have the best doctor in town. Besides, cancer treatment is really good these days." the nurse is giving the patient ________
false reassurance
Hill Burton Act
federal act that encourages every community to build a hospital, increase demand equals increase use of health providers
Within the communication process the ________ the the response to the message
feedback
During evaluation of the nursing process, if goals are partially met _________
figure out why
Lillian Wald
founded Henry Street Settlement-1st public health nursing
Isabel Hampton Robb
founded the NLN and ANA
Clara Barton
founded the Red Cross
Mary Breckenridge
founder of Frontier Nursing Service
Mary Breckinridge
founder of Frontier Nursing Service
The ASBN can revoke or deny a license for any of the following except: a. practicing without a license. b. being guilty of a crime or gross immorality c. incompetence (negligence, habits, or other causes) d. drug addiction e. mental incompetence f. unprofessional conduct g. associating with a felon
g. associating with a felon
summarizing _________ the patient has made is an important activity during the termination phase of the nurse-patient relationship
gains
Using King's model in practice, Nurses focus on __________ for an by the patient
goal attainment
Planning
goals are identified and nursing interventions selected
Theories
group of related concepts, definitions, and statements guides nursing practice by describing, explaining, predicting, and controlling phenomena, or patient behavior and outcomes
atherosclerosis
hardening of the arteries in which yellowish, fatty plaque is deposited on the wall
NIC and NOC provide nursing with treatment language that is essential for computerized _____________
health care records
Human dignity
i. Providing culturally competent and sensitive care ii. Protecting the patient's privacy iii. Preserving confidentiality of patients and health care providers; and iv. Designing care with sensitivity to individual patient needs.
Social Justice
i. Supports fairness and non-discrimination in the delivery of care; ii. Promotes universal access to health care; and iii. Encourages legislation and policy consistent with the advancement of nursing care and health care.
During the _______ stage of the nursing process the nurse puts the nursing strategies into action
implementation (fourth)
During which stage of the nursing process does carrying out nursing and physician orders take place?
implementation (fourth)
Implementation normally includes _________ the strategy
implementing
hydrocephalus
increased amount of cerebral spinal fluid in the ventricles of the brain, which causes enlargement of the cranium.
encephalitis
inflammation of the brain
cerebellitis
inflammation of the cerebellum
duritis
inflammation of the dura mater
endocarditis
inflammation of the inner lining within the heart
bacterial endocarditis
inflammation of the inner lining within the heart caused by bacteria
lymphadenitis
inflammation of the lymph glands
meningitis
inflammation of the meninges
myocarditis
inflammation of the muscle of the heart
neuritis
inflammation of the nerve
pericarditis
inflammation of the outer double layer of the heart
Laissez-faire
informal, little or no guidance
A critical thinker gathers and assesses relevant _______ and can effectively interpret it
information
An essential part of nursing is providing _________ to patients and their significant others and is also a helpful responding technique
information
Assessment
information about the client is collected, may be physical, psychological, social, spiritual ex: physical health assessment data
Mahoney
initiated integration of Nursing
lumbar puncture
insertion of a needle into the subarachnoid space between the third and fourth lumbar vertebrae. It is performed for many reasons, including the removal of cerebrospinal fluid for diagnostic purposes.
Service Learning
instructional method that combines community service with academic instruction and focus on reflective thinking
The ________ system in King's model deals with interactions and transactions between two or more people
interpersonal
vaginismus
involuntary contractions
Licensure
is required by law to practice nursing in each state
Good Samaritan laws
laws that protect a healthcare professional from being sued as a result of providing emergency care outside a healthcare setting. The provider must provide the care in the same manner that an ordinary, reasonable, and prudent professional would in similar circumstances, including following practice standards.
Negligence
nurse is judge against an ordinary, reasonable, prudent layperson would do or not do in similar circumstances.
Formal Socialization
lessons planned during school, shadowing and clinical experiences
When prioritizing a nurse can use the ___________ as a franework which involves an inverse relationship between high-priority nursing diagnoses and high-level needs
maslow's hierarchy of needs
Clinical specialist
masters degree offered in any clinical area-usually work in hospital settings
CRNA
masters degree that prepares nurses to deliver anesthesia
Informal Group
may have different leaders at different times, leaders are not appointed or voted in
A person who is a poor listener may fail to recognize levels of ________
meaning
________ diagnosis described a specific disease process and is oriented to pathology
medical
_________ diagnosis is a well developed classification system consisting of 2/3 words
medical
Within the communication process the ________ is what is actually said plus any accompanying nonverbal communication
message
Nursing philosophy ties together the concepts of the nursing's __________
metaparadigm
__________ portion of nursing knowledge consists of the major concepts of the discipline: the person, environment, health and nursing
metaparadigm
____________ refers to the most abstract aspect of the structure of nursing knowledge
metaparadigm
_________ is defined as narrower in focus and makes connections between grand theories and nursing practice
middle-range theory
Legal/Law
minimal morality
NIC and NOC facilitate the implementation of a nursing __________
minimum data set
Standards of practice
minimum guidelines identified by the profession and healthcare organization policies and procedures. Expert opinion, literature, and research also may be used as standards. Standards are used in legal situations to assess negligence malpractice actions.
Protected Population
minors veterans handicapped pregnant woman prisoners mental people
Negligence
misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person
PT: restore ____________ to injured limbs, etc., pain management, musculoskelal issues a. strength b. health c. mobility d. color
mobility
Women who are more sexually assertive tend to experience orgasms less/more frequently
more
• Durable Power of Attorney
name a person to make decisions for you if you are unable to do so; can list decisions you desire
angiostenosis
narrowing of the blood vessels
WWII
need for nurses brought about the Cadet Nurse Corp.
War on Terrorism
need for nurses identified esp. mental health practitioners
Malpractice
negligence as being a professional
neurasthenia
nerve weakness (nervous exhaustion, fatigue, and weakness)
Amenorrhea
no menses Seen in anorexia nervosa
The ______ level of communication involves aspects which depend on body language
non-verbal
grooming, clothing, gestures, posture, facial expression, eye contact, tone and volume of voice, an actions are all considered __________ communication
nonverbal
Doctorate (DNP)
not a PhD program- practice focused doctoral degree program
Trial and Error
not a good method to problem solve, come up with several solutions and try them all until one works
Silence
not absence of communication, allow patient to gather thoughts, say nothing when we don't know what to say
RN
o Assess & monitor health status o Plan, implement, evaluate nursing care interventions o Coordinate and oversee pt care o Anticipate risks and intervene to prevent complications o Focus on health promotion and patient education
• Recognize the nurse's responsibilities with advanced directives
o Assess a patient to see if their wishes are documented/ would like to have an advanced directive o Patients have a right to revoke advanced directive- notify physician if patient would like to change status o Document conversations with patient about advance directives o Nurse as patient advocate
• Explain the purpose of documentation and key issues related to informatics and documentation
o Clear, accurate, and accessible documentation is an essential element of safe, quality, evidence-based nursing practice o RN, APRN are responsible and accountable for nursing documentation that is used throughout an organization o Used to communicate within the healthcare team, communicate with other professionals, verify credentialing, provide legal support, learn about regulation and legislation, receive reimbursement, do research, and conduct quality process and performance improvement o Three areas where hospitals often did not meet compliance: • Complete and accurate medical record • Verbal orders received and recorded by qualified staff • Patient assessed and reassessed per defined time frame
• Recognize the purpose of the AHA Patient Bill of Rights
o Clients have the right to participate in their own care; emphasis is on client autonomy
• Describe informatics and its relationship to nursing
o Complex and changing daily o Definitions and Description • Email, websites • QI • Insurers • Key Terms Related to Informatics o Nursing Standards: Scope and Standards of Nursing Informatics • Increased emphasis on informatics as a healthcare profession core competency • Major concepts related to information • Flow from data to wisdom o Certification in Informatics Nursing • Application eligibility criteria o Informatics: Impact on Care • Informatics can lead to safe, quality care • Nurses need to take active role • Information sharing and coordination of care o Implications for Nursing Education and for Nursing Research • More online courses and interactive learning • Greater use of IT by students • Use of informatics in nursing research
• Explain patient rights contained in the Patient Bill of Right
o Considerate and respectful care o Be informed about illness, treatments, outcomes, have questions answered o Know the names and roles of those involved in care o Consent or refuse treatment o Have an advanced directive o Privacy, confidentiality o Review medical records
• Explain the IOM competency: Work in interprofessional teams
o Cooperate, collaborate, communicate, integrate care in teams to ensure care is continuous and reliable o Are healthcare professionals prepared to participate effectively in interdisciplinary teams? • IOM says no • Healthcare professional education takes place in isolation • Nurses tend to focus on nursing care plan, not total plan of care
Renaissance
o Dark period for nursing o Prostitutes and prisoners served as nurses o Fighting, foul language, petty theft o Expansion of scientific knowledge o Divinci - anatomy o Small pox vaccine o Stethoscope developed o Began to think of disease prevention
Alcohol has lots of consequences:
o Delirium tremens (the DTs) - alcohol withdrawal syndrome o Social consequences o Liver damage (cirrhosis) o Nutritional problems (Korsakoff's syndrome) -Fetal alcohol syndrome in pregnant mothers
Deontology
o Duty based • Look at the underlying principles of actions o Categorical imperative - Immanuel Kant • Treat any person as an end in him/herself, never as a means to an end o Rules derived from universal values that underlie all major religions o The duty to tell the truth is more important than the utility of calming a patient down o These concepts are similar to the legal system
• Discuss communication and its relationship to patient care and teams
o Effective communication takes practice and awareness o Use I statements when communicating feelings o Use you statements when persuading others. o Intervene calmly and confidently o Respond to problems in a timely way to avoid accumulation of negative feelings o Relational coordination at work • Frequent, high quality communication that is timely, accurate, and uses problem solving • High quality relationships that include shared goals, knowledge, and mutual respect. o Assertiveness • Assertiveness vs. aggression • Suggestions for improving assertiveness • Nonverbal messages
Recovering nurse program
o Example of an alternative to the disciplinary process o LSBN recognizes the disease entity of chemical addiction
Teleology (Utilitarianism)
o Greatest good for the greatest number o How an act affects the happiness or welfare of each individual is not given consideration- it is the total amount of good is decisive, not how equally it is distributed o Does the nurse have a duty to tell the truth? Only when it serves the greater good of the greatest number of patients
• Discuss the IOM competency: Utilize informatics.
o How technology is used to prevent errors, improve care o Impact of informatics on nursing o IOM competencies required of every healthcare professional o Position statement from the Healthcare Information and Management System
• Describe the IOM competency: provide patient-centered care
o Identify, respect, & care about patients differences, values, preferences, & expressed needs o Relieve pain and suffering o Coordinate continuous care o Listen to, clearly inform, communicate with, and educate o Share decision-making & management o Advocate disease prevention, wellness o Promote healthy lifestyles
• Define teamwork
o Increasing complexity of care and concerns about fragmented healthcare system makes teams more important - complex needs of patients (NICU)
• Examine collaboration and its relationship to patient care and teams
o Integral part of patient-centered care o Definition • All people are listened to • Decisions are made together • Increases the chance of having the best decision o Effective collaboration requires • Open communication • Team members comfortable expressing opinions
• Identify limits to confidentiality
o Should be explained by a nurse or therapist at the onset of therapy o Contagious diseases o Insurance company o Health care providers o Health care proxy or guardian o There is legal "duty to warn"
• Identify patient rights with regard to confidentiality
o Know of relationships between the hospital and physician and outside parties o Consent or refuse to take part in research o Realistic health care alternatives if hospital care isn't appropriate o Be informed of hospital rules that affect treatment, charges, and payment methods. o Clients can decide to become organ donors o Clients can refuse an organ transplant
• Explain informed consent, the purpose of it, and requirements for it
o Legal documents that indicate client's consent or permission o Includes explanation of benefits, risks, consequences for not having procedure done, treatment options, name of health care provider, questions answered, right to decline. o Those medicated with sedation should not be asked to sign a consent. o One must be competent to give consent, or have an appointed guardian or a durable power of attorney to give consent. o A competent person >18 can give consent. o Consent • Persons have a right to be free from harmful or offensive touching • Providing care to a person without their consent is a battery • Consent obtained without informing the patient may be grounds for liability for negligence
Accreditation of Schools of Nursing
o National League for Nursing (NLN) o American Association of Colleges of Nursing (AACN)* o National Organization of Associate Degree Nursing (N-OADN)
Certification & Credentialing
o Not required by law o Certification of expertise in an area o Offered by specialty organizations and ANA
• Recognize nurses rights contained in Nurses Bill of Rights
o Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care. o Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. o Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses and its interpretive statements. o Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution o Nurses have the right to fair compensation for their work, consistent with their knowledge, experience and professional responsibilities. o Nurses have the right to work in an environment that is safe for themselves and their patients. o Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings. o Nurses have the right not to be abused in any form by physicians, pharmacists, administrators or nursing directors. Any abuse that occurs should be dealt with in a professional and impartial manner by the nurse's employer. o Nurses have the right not to be exploited and abused by being floated to areas of practice that they are not familiar with. o Nurses have the right to refuse any assignment that they feel is unsafe. Such as when a nurse is assigned a patient load he/she feels is unsafe. A nurse is assigned to work in an area of nursing in which he/she is not familiar. A nurse knows that equipment/supplies are inadequate or not available
• Support the need for patient advocacy
o Nursing standards support advocacy, requires leadership skills o Nurses need to learn about patient values, preferences o Collaborate to work for the best outcome, respecting the patient's beliefs and values and providing information for understanding about treatment and care needs
• Describe the standard of care owed to patients by nursing students
o Nursing students owe patients for whom they care the identical standard of care owed to the patient by the registered nurse. o Students must provide the same competent care that the reasonably prudent nurse would give. • Know hospital policy and procedure • Be current in nursing knowledge
• Explain the need for self-management of care.
o Patient use of self-management of care supported by providers • Increased involvement means higher satisfaction
positive impact on the image of nursing
o Power and empowerment o Visibility
Recognize rights of nursing students (admission requirements, disciplinary and grievance procedures, safe environment, and confidentiality of records).
o Prohibits discrimination in admission to nursing schools based on race, creed, sex, color, national origin, handicap, or marital status. o Makes students responsible for maintaining standards of academic performance o Nursing schools should have disciplinary and/or grievance procedures. o At FSU, students must earn a C or better (75%) to be considered passing.
• Discuss the importance of consumerism in health care
o Relates to patient-centered care o Customer-centered health care means that the nurse must be more aware of customer/patient needs o Nurses to find a balance- meeting patient needs, including the patient, and respecting the patient's opinion o Important customer service goals • Caring with compassion • Making sure caring comes across • Paying quality attention • Reducing patient anxiety • Your personal calling- are you committed
• Examine the impact of the use of biomedical equipment on nursing care
o Remote telemetry monitoring- staff are informed of the patients identity, heart rate, and readout of rhythm without being next to patient o Robotics- provide remote presence to allow physicians to virtually examine patients by manipulating remote cameras o Genetics and genomics- have dramatic impact of patient care • Advances in customized patient care and medications targeted to individual responses to medications • Change how patients are managed for specific diseases and conditions and extend into the prevention of some diseases • Patients will need to be partners in this development as part of patient-centered care
• Explain the purpose of and requirements for the Patient Self Determination Act
o Requires Medicare and Medicaid providers to give adult individuals, at the time of admission or enrollment, information about their rights under state laws governing advanced directives. o Right to participate in and direct their own health care decisions o Right to accept or refuse medical or surgical treatment o Right to prepare an advanced directive o Information on the provider's policies that govern the utilization of these rights o Allows the person to enact "Do not resuscitate directives o Prohibits discrimination if one does not have an advanced directive o Patient self determination: • Involves the right of individuals to decide what will or will not happen to them as well as documentation describing these wishes. • This term generally describes advanced directives.
• Describe areas of negligence for which nursing students may be held accountable
o Students are responsible for their own actions and may be liable for their own negligence. o Students do not practice on their instructor's license. Students practice as an exception to the licensure law
Summarize Harvard Medical School's recommendation for medical errors.
o Tell the patient and family what happened. o Take responsibility o Apologize at once o Explain what will be done differently in the future.
• Describe faculty responsibilities in relationship to nursing students
o The freedom to teach and the freedom to learn are inseparable facets of academic freedom: students should exercise their freedom in a responsible manner. o Faculty are responsible for teaching their students and making sure they perform proper care and procedures
dentify confidentiality and security concerns of electronic information
o The nurse does not reveal personal or health-related information concerning the patient without either the patient's consent or sufficient cause. o Essential in the establishment of a trusting nurse-patient relationship o Requires nondisclosure of private or secret information with which one is entrusted o Only those directly involved in care should know details o Do not discuss patient conditions in public places. o HIPAA • Mandates the development of a centralized electronic database with health records for every person in US • Attempt to simplify & standardize electronic forms required for claims for services • Federal law protects patient confidentiality in medical records • Restricts the posting of patient information on whiteboards or signage viewed by patients/visitors • Don't leave messages for patients on answering machines or with family members. Don't call employment sites without permission. • Shread papers with PHI • Use cover sheets when faxing, and fax only to secure locations
Florence Nightingale
o Well educated o Holistic view of health: body, mind o Saved many lives in Crimean war o Focus on cleanliness & Nutrition o Founded first nursing school 1860 o Focused on data and outcomes o Layed foundation for evidence based practice: Notes on Nursing
• Explain advanced directives
o Written instruction related to the provision of health care in the event one becomes unable to make decisions. Examples: • Living Will • Durable Power of Attorney • Appointment of Health Care Surrogate
LPN
o administration of treatments and medication o Assist with ADL o under the direct supervision of a RN, a licensed physician or dentist o May supervise CNAs in nursing homes and assisted living facilities
A sign is a type of _______ data
objective
_______ data is measurable
objective
_________ data is data which is detectable by the observer or tested against an acceptable standard
objective
Conventional
one learns to conform to the rules of society, mold their behavior to suit the roles of society
Post-conventional
one uses abstract universal principles of justices to make moral decision, principled reasoning
Active listeners have _______ posture
open, erect
__________ are important responding techniques used by nurses which cause the patient to answer fully, giving more than a yes or no answer
open-ended questions
ANA
organization that represents all RNs in the U.S. o Labor union- option for members to participate o Strategic imperatives- professional practice and excellence, healthcare and public policy, knowledge and research, unification, advocacy for workforce, and organizational effectiveness
The ________ phase of the nurse-patient relationship is an introductory phase which is often described as the "getting to know you" in social settings
orientation
Using Henderson's philosophy of nursing, a nurse should adopt an _______ to care from the perspective of the ______ basic needs
orientation; 14
Nurse Practice Act
passed thru legislature, varies from state to state, members appointed, enforced through the Board of Nursing
A ___________ is a primary means of obtaining both subjective and objective data during the assessment stage of the nursing processs
patient interview
Informed Consent
patient must be given opportunity to provide treatment
Retrospective Payment
payment after care is given
Prospective Payment
payment before services are give
Defendant
person against whom a lawsuit is filed. must show that the plaintiff is unable to prove the 4 elements of negligence or malpractice liability.
martha rogers
person is an irreducible whole, relationship between person and environment, non-contact therapeutic touch
Florence Nightingale
person is influenced by the environment Nursing is a calling to help patients in a reparative process directly working with the patient or indirectly by affecting the environment to improve health or recovery from illness
• Appointment of Health Care Surrogate
person you choose to make health care decisions for you
The _______ system in King's model identifies concepts the provide an understanding of individuals, personally and interpersonally
personal
Values
personal ideals and beliefs about worth that act as a guide to behavior
Morals
personal standards of right and wrong
• Living Will
pertains to situations involving terminal illness; persistent vegetative state is not considered terminally ill
a __________ of nursing provides a broad, general view of nursing that clarifies values and answers broad disciplinary questions such as : "What is the profession of nursing" and " What is the nature of human caring"
philosophy
In Maslow's hierarchy of needs, the highest priority is given to diagnosis related to _________ needs.
phyiological
A __________ is a method for obtaining data during the assessment stage of the nursing process which involves the nurse's techniques of inspection, auscultation, percussion and palpation
physical examination
Attitudes
position, point of view
OT: adaptive devices to regain ______________ tools. a. practical life b. job skill c. communication d. mobility
practical life
The ultimate goal of nursing theory is to support excellence in _______
practice
After diagnoses are identified the nurse must put them in order of _______
priority
Critical Thinking
process by which the thinker improves the quality of thinking by taking charge of the thinking process and imposing intellectual standards upon the inherent thinking
cerebral angiography
process of x-ray filming of the blood vessels in the brain (after an injection of contrast medium)
computed tomography of the brain
process that includes the use of a computer to produce a series of images of the tissues of the brain at any desired depth. The procedures is noninvasive, painless, and particularly useful in diagnosing brain tumors. Also referred to as a CT scan or CAT scan for computed axial tomography.
amyotrophic lateral sclerosis (ALS)
progressive muscle atrophy caused by hardening of nerve tissue on the lateral columns of the spinal cord. Also called Lou Gehrig's disease.
NLN
promotes excellence in nursing education to build a strong and diverse nursing workforce o Represents all nursing programs
Primary prevention
promotes patient wellness by stress prevention and reduction of risk factors.
CARING
promoting health, healing, and hope in response to the human condition
define under what conditions and circumstances a nurse is allowed to treat the patient
protocols
meningocele
protrusion of the meninges through a defect in the skull or vertebral column
secondary characteristics
providing framework for cultural assessment, diff and similarities between you and the patient and differences can lead to difficulty o Educational status o Socioeconomic status o Occupation o Military experience o Political beliefs o Urban vs. rural residence o Enclave identity o Marital status o Parental status o Physical characteristics o Sexual orientation o Gender issues
Utilitarianism
published by David Hume, moral rightness of action, based on sequence, greatest good for greatest number of people
A critical thinker gives reasoned consideration to evidence, context theories and criteria in order to form a ________
purposeful judgement
A critical thinker raises vital _____ and _______, formulating them clearly and precisely
question; problems
o Disparities
racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention. • Individual factors: • Race/ethnicity, age, gender • Income, occupation, education • Disabilities, rural or urban residency, and sexual orientation • Cultural norm and values, literacy levels, and environmental and occupational exposures • Interventions: promoting healthy lifestyles and reducing health risk behaviors • Healthcare system factors: • Rates of access to and utilization of health care vary among population groups • Insurance status and affordability • Transportation
fibrillation
rapid, quivering, noncoordinated contractions of the atria and ventricles
Ethics
rational processes for determining the best course of action in the face of conflicting choices
During evaluation of the nursing process, if goals are not met __________
reassess and modify a new plan of action
Implementation normally includes _______ of client
reassessment
electroencephalogram
record of the electrical impulse of the brain
Dix and Barton
recruited nurses in the civil war
_________ is an important aspect in professional boundaries in which the nurse focuses on his/her own thoughts, feelings, actions and beliefs
reflective practice
Comprehensive Drug Abuse Prevention and Control Act
regulates drugs with high potential for abuse: narcotics, stimulants
The _________ operation of orem's model is when the nurse designs, plans, and produces a system of care
regulatory
Group-3 or more individuals
relationships make them in some way to interdependent and interact for a goal or purpose
BAC = 0.06
relaxation and comfort
Restatement
repeat back to clients exact words, patient knows you heard, encourages client to continue
board of directors
represent various businesses and political interests of the community. Responsibilities include high quality care, financial oversight, medical staff credentialing, long range planning
AACN
represents university and baccalaureate programs in nursing o Activities include educational research, government advocacy, data collection, publishing, and initiatives to establish standards for BSN and graduate degree o Concerned with development of standards and resources and promotes innovation, research, and practice to advance nursing education o Involved in accreditation of university nursing programs through its commission on collegiate nursing education o Only represents university-level nursing education programs
INTEGRITY
respecting the dignity and moral wholeness of every person without conditions or limitation
____________ is a professional boundary which has to deal with a person's own emotional needs being met outside of the nurse-patient relationship
self- awareness
Primary Care
services that allow entrance to health care system, treats clients that don't require hospitalization (minor, acute, ER, clinic)
__________ is a helpful response in the nurse-patient relationship which allows for periods of quiet thought during an interaction without feeling pressure to dill the silence with conversation or activity
silence
Under the nursing process, nurses benefit in meeting professional _______
standards
unconsciousness
state of being unaware of surroundings and incapable of responding to stimuli as a result of injury, shock, or illness.
health
state of optimal functioning or well-being
coma
state of profound unconsciousness
Philosophy
the study that underlie professional conduct, gives reasoning to the profession, accepted by profession
Code of Ethics
stated by ANA, guide for practice
Philosophy of Nursing
statement of beliefs about nursing that demonstrate our values, used to make decisions, ethic issues, critical thinking
Tertiary Prevention
stopping the disease from progressing, "rehab, therapy"
Cohen
student socialization unilateral dependence, indepence,... etc
seizure
sudden attack
Veracity
telling the truth, our duty to be honest
Short term changes from substances
temporary changes in behavior, emotion, thought
During the _________ phase of the nurse-patient relationship does the nurse review accomplished goals with the patient
termination
Data which is gathered from other health care providers, medical records or other reports is known as a ________ source
tertiary
lymphoma
tumor of lymphatic tissue
During the planning stage of the nursing process, goals are written as " _________ "
the client will
Professionalism
the demonstration of high-level personal, ethical, and skill characteristics of a member of a profession
"bad trip" of hallucinogens
the experience of enormous unpleasant perceptual, emotional and behavioral reactions
Supply
the goods and services, the hospitals and providers, nurses
Demand
the illnesses and the consumers, patients Demand exceeds supply, price goes up. Reversible
Reward and Punishment
the way of value transmission where one is reprimanded for bad behavior and congratulated for good behavior
Alternative
therapies that replace allopathic medical care
Team Task Roles
these roles help accomplish the objectives of the group -Initiator: suggest new ideas to the group -Information Seeker: seeks clarification of issues, facts -Opinion Seeker: seeks clarification of values -Information Giver: offers facts -Opinion Giver: offers beliefs -Elaborator: spells out suggestions with examples -Summarizer: pulls together ideas and concepts to help group identify where they are in their thinking -Coordinator: clarifes and coordinates relationships between ideas -Disagreer: takes a different point of view -Critic/Evaluator: questions the logic or process -Energizer: prods the group to action -Recorder: keeps written record of groups work
Structure Standard
these standard are held by institution or setting so quality healthcare can be delivered; i.e.: - it includes people money, equipment, staff - 1 RN for every 8 to 10 patients - includes the philosophy goals and objectives
Patient Self-Determination Act
this is the legal standard for patients' autonomy: • Make own health care decisions • Accept or refuse medical treatment • Advanced directives (living will, power of attorney)
Criminal Law
those statutes that deal with crimes against the public and members of the public, with penalties and all the procedures connected with charging, trying, sentencing, and imprisoning defendants convicted of crimes.
panplegia
total paralysis
Latent Power
underused power (nursing)
Long-term changes from substances
use can lead to develop TOLERANCE (needing to increase dose for same effect) & WITHDRAWAL symptoms
Systems Theory
use to understand the concepts of nursing
chief nurse executive/officer
vice president for nursing or director of nursing
concussion
violent jarring or shaking that results in an injury. Brain concussions are caused by slight or severe head injury; symptoms include vertigo and loss of consciousness.
Voluntary/Private
volunteer money supports their agency, grants from government, focuses on certain disease (Red Cross)
For Profit
want to make money, business, go back to shareholders
Under which philosophy of nursing are nurses encouraged to share their genuine selves with patients?
watson
Under who's philosophy of nursing is nursing described as a human- to - human relationship
watson
Which philosophy recognizes, supports and encourages patients' spiritual strengths
watson
Active Listening Open posture Venting Empathy Open-Ended Questions Giving Information Reflection Silence
ways to improve communication
Health Promotion
wellness activities, early disease detection, education, prevent risk factors from developing, active participation, self-responsibility
• Failure to follow the institutions policy and procedure • Administering care although not adequately trained • Improper delegation of duties to someone not properly trained • Failure to record nursing actions • Documenting on the wrong chart
what are some common breaches of standard care?
Assessment Diagnosis Outcomes Identification Planning Implementation Evaluation
what are the six standards of practice in the nursing process?
standard of care
what is the standard to which an expert witness will testify?
Pre-conventional
what part of moral development is best described by good and bad = reward and punishment?
Standard 1: Collecting Health Status Data
what standard is this: 1) The priority of data collection is determined by the individual's immediate condition and needs. 2) The collection and recording of data provides for systematic collection, frequent updating, accessibility, and appropriate confidentiality.
1976
what year was the modern ethics code written?
Prizing
with pride, happiness, public affirmation
myelogram
x-ray film of the spinal cord (after injection of dye into the spinal fluid that surrounds the spinal cord)
vaginismus
~ Sexual Pain Some women experience involuntary contractions of the muscles of the outer third of the vagina -Relatively little research; in fewer than 1% of all women -Severe cases can prevent a woman from having intercourse •Cognitive-behavioral theory (most agree) that this form of genito-pelvic pain/penetration disorder --> is a learned FEAR response! -A variety of factors: anxiety & ignorance about intercourse exaggerated stories trauma caused by an unskilled partner trauma of childhood sexual abuse or adult rape
o Examples of informatic types and methods:
• Automated dispensing of medications and bar coding • Computerized monitoring of adverse events • Electronic Medical/Health Records (EMR) • Personal Health Record (PHR) • Professional Order Entry System (POES) • Clinical Decision Support Systems • Use of Personal Digital Assistants • Computer-Based Reminder Systems • Access to Patient Records at Point of Care • Internet Prescriptions • Nurse Call Systems • Voice Mail • Telephone for Advice and Other Services • Online Support Groups for Patients and Families • Internet or Virtual Appointments • Smartphones
what all nurses can do to improve the image of nursing.
• Be visible! • Be actively involved in policy and funding decisions, particularly any changes that impact nursing care but also broader healthcare issues
essential nursing caring behaviors
• Essential and central to nursing, defined by many nurse theorists like Watson • Varies among cultures and differs in individuals • Caring can be doing for other people what they cannot do for themselves, care of medical problem, and competence in carrying out all • Comfort, Compassion, Concern, Coping Behavior, Empathy, Enabling, Health Consultant, Helping, Interest, Involvement, Kindness, Love, Nurturing, Presence, Protective, Restorative, Surveillance, Teaching, Touching, Trust, Sharing, Stimulating, Stress alleviating, Supportive • Comfort Needs are physical, psychological, social, and environment • Caring defined at FSU o Nurse's empathy for and connection with the patient. o The ability to translate these affective characteristics into compassionate, sensitive, appropriate care.
o High-touch care
• Face to face communication
o Characteristics of tasks that can NOT be delegated
• Health counseling, teaching • Activities that require independent, specialized nursing knowledge, skills, or judgment
o Health Literacy: A Barrier
• Inability to understand, follow directions • Increased need for interpreters (not family) • A silent epidemic
Tertiary Care
• Intensive care • Sub-acute care
the role and responsibilities of the State Boards of Nursing.
• Made up mostly of nurses • Are given authority by statutory law • Enforce Nurse Practice Acts o Regulate nursing practice, including requirements to enter practice and obtain and maintain a license (NCLEX, education, fee) • Oversee Schools of Nursing • Control Licensure o Requires a minimum degree of competency to ensure that public health, safety, and welfare are reasonably protected. • Discipline nurses
• Interprofessional (more accepted term of interdisciplinary)
• Maintain mutual respect and shared values • Use knowledge of all to address patient needs • Communicate responsively, responsibly, and supportively • Apply relationship-building values to deliver patient centered care
• Multidisciplinary
• Members of different disciplines assess or treat patients independently and then share information with each other
Unintentional Tort
• Negligence • Malpractice
o Patient/Family Education: Inclusion in Plan of Care
• Patient teaching cannot be delegated • Barriers to effective teaching • What is effective education?- Patient is able to restate and properly show how to do procedures
• Interdisciplinary
• People with distinct disciplinary training work together for a common purpose as they make different, complementary contributions to patient-focused care • Emphasizes collective action and in depth collaboration in planning and implementing • Leadership varies depending on the situation • All members work together to come up with solutions • Collaborate to see the bigger picture
Primary Care (Health Promotion)
• Prenatal and well-baby care • Nutrition counseling • Family planning • Exercise classes
principles concerning the action of the nurse in relationships with patients, families, other health care providers, policy makers, and society.
• Privacy of the patient's interests • Conflict of interest for nurses • Collaboration • Professional boundaries
Explain professional nursing boundaries
• Professional boundaries are the spaces between the nurse's power and the client's vulnerability • Nurse should avoid these behaviors: o Self-disclosure of one's own personal information, secretive behavior between the nurse and a patient, special treatment by nurse, selective communication, super nurse (the nurse thinks he or she is the only one who can care for the patient), you and me against the world thinking, and failure to protect the patient.
reasons to carry professional malpractice insurance
• Protects the individual nurse when a lawsuit is filed. • Provides independent representation by an attorney. • Pays for judgments up to the policy limit. • May include representation in licensure actions. • Provides compensation to client if harmed.
the IOM's 5 core competencies for Health Care Professionals
• Provide patient centered care • Work with interdisciplinary/interprofessional teams • Employ evidence based practice • Apply quality improvement • Utilize informatics
o How is care coordination accomplished
• Provide patient-centered care
the purpose of incident reports & why, when, & how to do them
• Purpose: to assist in developing policies and procedures to improve practice; improve quality of care. • Why: Nurses are legally bound to report critical incidents. • When: Do when a critical incident occurs. • How: Describe events objectively. Avoid subjective comments/personal opinions.
magnet hospitals
• Recognized by ANCC • Measure the strength and quality of nursing • Where nursing delivers excellent patient outcomes, have a high level of job satisfaction, low staff nurse turnover, appropriate grievance resolution • Indicated nursing involvement in data collection and decision making in patient care • Value staff nurses
ethics/bioethics committee
• Resource/education for ethical information • May be asked to consult on policy • May be asked to consult on a specific case • Often members have formal training in ethics
o Delegation Principles
• Responsibility, accountability • Delegating components of care • Delegation based on RN's judgment • Individualized communication
the purpose and functions of the Nurse Practice Act.
• State Statute that defines and regulates the practice of nursing to protect the public o Define the scope and boundaries of practice o Create and empower a Board of Nursing to oversee licensee o Establish the requirements for licensure and entry into practice o Establishes standards for nurses utilized by courts o Violations result in civil or criminal prosecution
o Concerns to address for effective informatics
• Support services • Staff training • Planned change
o Telehealth
• Telemedicine- the use of telecommunications equipment and communications networks for transferring healthcare information between participants at different locations (two-way interactive video) • Offers opportunities to provide care when face to face interaction is impossible • Two-way interactive video is the most effective telehealth method • Telenursing refers to the use of telecommunications technology in nursing to enhance patient care • Issues: • Cost of equipment and use • Training for staff and for patients if they need to actively use equipment • Limited or no insurance coverage for telehealth services • Need for clear policies • Privacy and confidentiality • Regulatory issues
o What is the purpose of care coordination?
• To establish and support a continuous healing relationship, enabled by an integrated clinical environment with proactive delivery of evidence-based care
the characteristics of a profession and why nursing is a profession
• Well-defined body of knowledge • Enlarge the body of knowledge through research • Educated in institutions of higher education • Apply knowledge providing services vital to society • Exalt service above personal gain • Freedom of action, professional growth, economic security • Practice autonomously • Enforce a Code of Ethics
• Recognize a breach of confidentiality
• When client's trust and confidence are violated by public revelation of confidential or privileged communications without the client's consent. • Disclosure of information to family members is not acceptable unless the client gives permission.
• Identify staff safety issues in the healthcare workplace environment.
• needlesticks 1,000/year (need safe needle devices • back injuries' • violence: crime, customers, worker on worker, spillover of DV • chemical exposure: OSHA (asthma, miscarriage, cancer, birth defects
o Delegation
• transferring a task to a competent individual • Nurse is still accountable (responsible and answerable) for the outcome • Care is provided more efficiently
• Identify events that Medicare/Medicaid will no longer reimburse for beginning 2011
• transfusing the wrong blood type • falls that result in dislocation, fractures, or head injuries • burns and electric shocks • catheter-associated urinary tract infections • surgical site infections after bariatric surgery or coronary artery bypass • manifestations of poor glycemic • performing the wrong procedure • performing the procedure on the wrong body part, or performing the correct procedure, but on the wrong patient
• Recognize JCAHO goals to prevent medical errors.
• •Improve accuracy of patient identification • •Improve effectiveness of caregivers communication • •Improving safety of using high-alert medication • •Eliminate wrong-site, wrong-patient, wrong procedure surgery • •Improve the safety of using infusion pumps • •Improve the effectiveness of clinical alarm systems
• Identify factors that contribute to medication errors & specific ways to prevent them.
•Incomplete patient information (other medications taken, previous diagnosis, and lab results) •Unavailable drug information (such as, lack of up-to-date warnings) •Lack of appropriate labeling as a drug is prepared and repackaged into smaller units •Illegible handwriting •Using wrong drug name or dosage •Patient history of allergy to same medication class •Decline in renal or hepatic function requiring alteration of drug therapy, overdose in elderly is more common •Incorrect dosage calculations •Absence or presence of leading and trailing zeroes (0.1 or 1.0) •Incomplete medication orders •Misinterpreted abbreviations •Atypical or unusual and critical dosage frequency considerations
• Recognize AHRC patient safety indicators. Hospital-Level Patient Safety Indicators
•Accidental puncture and laceration. •Birth trauma -- injury to neonate. •Complications of anesthesia. •Death in low mortality DRGs. •Decubitus ulcer. •Failure to rescue. •Foreign body left in during procedure. •Iatrogenic pneumothorax. •Obstetric trauma -- cesarean delivery. •Obstetric trauma -- vaginal delivery with instrument. •Obstetric trauma -- vaginal delivery without instrument. •Postoperative hemorrhage or hematoma. •Postoperative hip fracture. •Postoperative physiologic and metabolic derangements. •Postoperative pulmonary embolism or deep vein thrombosis. •Postoperative respiratory failure. •Postoperative sepsis. •Postoperative wound dehiscence in abdominopelvic surgical patients. •Selected infections due to medical care. •Transfusion reaction.
• Recognize AHRC patient safety indicators. Area-Level Patient Safety Indicators
•Accidental puncture and laceration. •Foreign body left in during procedure. •Iatrogenic pneumothorax. •Postoperative wound dehiscence in abdominopelvic surgical patients. •Selected infections due to medical care. •Transfusion reaction.
Explanations and Effective Treatments for Paraphilia?
•Although various explanations proposed for paraphilic disorders --> little formal evidence to support them -NONE of the treatments applied have received much research/been proved clearly effective -Psychological & Sociocultural treatments around the longest, but TODAY also using Biological interventions
Causes of EXCITEMENT Disorders
•Biological Causes: -The SAME hormonal imbalances that can cause male hypoactive sexual desire can also produce ED! -Most COMMONLY: vascular problems involved •ED can also be caused by: Damage to the nervous system from various diseases, disorders, or injuries -The use of certain medications and various forms of substance abuse may interfere with erections (Medical procedures for diagnosing biological causes of ED) --> Measuring nocturnal penile tumescence (NPT) -Men typically have erections during REM sleep; abnormal or absent nighttime erections usually indicate a physical basis for erectile failure •Psychological Causes: -Psychological causes of male hypoactive sexual DESIRE can also interfere with AROUSAL and LEAD to erectile dysfunction! •For example, as many as 90% of men with severe depression experience some degree of ED -One well-supported cognitive explanation for ED emphasizes performance anxiety and the spectator role -This can create a vicious cycle of sexual dysfunction where the original cause of the erectile failure becomes less important than the fear of failure •Sociocultural Causes: -Sociocultural factors that contribute to male hypoactive sexual desire been linked to ED •Particularly relevant: Job and marital distress
Causes of Low Desire/sex drive:
•Biological causes: -A number of hormones interact to produce sexual desire and behavior --> abnormalities (Linked to ED) •prolactin, testosterone, and estrogen for both men and women -Excessive activity of the NTs serotonin and dopamine --> link according to recent investigation to sexual desire disorders -Some medications (including birth control pills and pain medications), some psychotropic drugs, a number of illegal drugs, and chronic illness •Psychological causes: (Linked to ED) -General increase in anxiety, depression, or anger may reduce sexual desire in both men and women -Fears, attitudes, and memories may contribute to sexual dysfunction -Certain psychological disorders (like depression and obsessive-compulsive disorder) may lead to sexual desire disorders •Sociocultural causes: (linked to ED) -Attitudes, fears, & psychological disorders that contribute to sexual desire disorders occur within a social context! •Many feeling situational pressures -Examples: divorce, death, job stress, infertility, and/or relationship difficulties •Cultural standards can set the stage for development •The trauma of sexual molestation or assault is especially likely to produce sexual dysfunction
• Identify the safety needs of special populations. Pediatric:
•Calculations based on weight •Accurate weight •Different volumes and concentrations •Renal, Immune, & Hepatic function
Disorders of Sexual Pain, known collectively as genito-pelvic pain/penetration disorder
•Certain sexual dysfunctions are characterized by enormous physical discomfort during intercourse and do not fit neatly into a specific phase of the sexual response cycle -Are experienced by women much more often than men •Some women experience involuntary contractions of the muscles of the outer third of the vagina (vaginismus)
goals of risk management
•Control cost of financial losses •Minimize occurrences of legal claims against the organization •Reduce injury to the lowest possible level •Protect the public •Protect healthcare personnel - maintain safe environment & equipment, tng, examine systems & Processes •Enhance quality of care provided •Maintain client satisfaction
ways to prevent malpractice
•Documentation •Use of standardized forms •Knowledge and skills of staff •Competency and accountability of staff •Quality improvement activities Risk management activities
• Explain the importance of public education of preventable medical errors
•Engage families in helping to improve patient safety. •Teach patients and families how to prevent errors. •Teach patients to question meds, etc
• Explain safety measures for high alert medications.
•Establish a good practice with another nurse •Do not store insulin and heparin near each other •Spell out the word unit •Remove concentrated KCl from stock •Educate staff on hydromorphone and morphine •Anticoagulants standardize concentrations •Remove heparin from top of medication carts •Remove NaCl concentrations >0.9%
Orgasm for sexual functioning mandatory?
•Female orgasmic disorder -Most clinicians agree that orgasm during intercourse is NOT mandatory for normal sexual functioning •Early psychoanalytic theory USED to consider lack of orgasm during intercourse to be pathological -Current evidence suggests that this is UNTRUE! -Once again, biological, psychological, and sociocultural factors combined factors •Because AROUSAL plays a key role in orgasms, arousal difficulties often are featured in explanations of female orgasmic disorder
• Discuss the human factors associated with preventable medical error.
•Inaccurate calculations •Workarounds •Incorrect equipment use •Miscommunications •Missed opportunities to perform quality control checks •Lacking teamwork •Resource management •Missing situational awareness
• Describe a culture of patient safety
•Produce an environment with a philosophy that safety is everyone's business from top down; A place where staff members feel it is safe to report a problem so the system can be changed to prevent a reoccurrence. •Develop reporting system that is a blame-free with open communication, analyzing the processes or system instead of pointing fingers at the individual by using quality improvement tools and finding root causes. •Report all errors, near-misses, and substandard care. •Disclose protocols & mistakes; acknowledge responsibility and apologize for the mistakes to the patients and families. •Make pharmacists part of the team.
• Define the tools and methods used to monitor and improve health care.
•Standards of Care •Policies and Procedures •Licensure and Credentialing •Utilization Review/Management (UR/UM) •Risk Management (RM) •Benchmarking •Assessment of Access to Healthcare Services •Evidence-Based Practice (EBP) •Clinical Pathways/Protocols •Institutional Review Board (IRB) •Healthcare Policy and Legislation
Causes of Premature ejaculation?
•The dysfunction seems to be typical of young, sexually inexperienced men •It may also be related to anxiety, hurried masturbation experiences, or poor recognition of arousal •One theory states that some men are born with a genetic predisposition •A second theory argues that the brains of men with early ejaculation contain certain serotonin receptors that are overactive and others that are underactive •A third explanation holds that men with this dysfunction experience greater sensitivity or nerve conduction in the area of their penis
• Recognize common abbreviation errors associated with medications
•U - mistaken for a zero or a four (4) resulting in an overdose •µg (microgram) - mistaken for mg or milligrams. 1 mg = 1000 mcg •Q.D. - the period after the Q is mistaken for an I resulting in QID (four times a day) rather than daily •Q.O.D. - misinterpreted as QD (daily) or QID (4x daily). If the O is poorly written, looks like a period or I. •SQ - mistaken as SL when poorly written •TIW - misinterpreted as three times a day or twice a week instead of three times a week •D/C - patient's medications have been prematurely discontinued when intended to mean discharge •AU, AS, AD - misinterpreted as the Latin abbreviation OU, OS, and OD (eyes instead of ears)
