Nursing Concepts
Non experimental designs
" Descriptive " or " exploratory " because the investigator is seeking to increase the knowledge base about a nursing phenomenon without manipulating variables__ Example: surveys, descriptive comparisons, historical documentary, evaluation studies May be either qualitative, quantitative or a combination of both
Goals begin with
" the client will " or "the client will be able to "
Originated the term
" therapeutic use of self " (1952)- verbal and nonverbal collab between you and patient. Must have relationship with client.
Profession:
"A calling, vocation, or form of employment that provides a needed service to society and possesses characteristics of expertise, autonomy, long academic prep, commitment, and responsibility"
the mission of the ANA is:
"Nurses advancing our profession to improve health for all." Improve the health of all (purpose) Organizations activities reflect off their mission.
Ambulatory care: ___% of nurses
10.5%
Natural Disasters (2001-2015)
2001 World Trade Center attacks 2005 Hurricane Katrina in New Orleans Nurses were called to act in conditions previously unimaginable and unaddressed Nurses responded by increasing preparedness
Average age of graduates from all nursing programs is____
31
National surveys of actively licensed nurses conducted approximately every ___ years and conducted by ______
4 years Federal government (latest: 2008- data available in 2010)
What percentage of licensed RNs under the age of 50 work full/part time?
90%
Which of the following is the most common type of basic nursing education program in the United States and graduates the most RN candidates of all the basic programs?
ADN programs
Who published a list of criteria that are characteristic of all true professions and that has stood the test of time?
Abraham Flexner
National League for Nursing (NLN, 1982):
Affirmed BSN as minimal educational level
Magnet hospitals:
Are "_nurse friendly_" Have low staff turnover and low vacancy rates Provide opportunities for professional and personal growth for nurses Greater _career satisfaction_
The nursing shortage prompted the creation of ______
Associate degree in nursing (ADN) programs
Convey empathy
Awareness of and sensitivity to others; identification of feelings of another person Difference between sympathy and empathy?
Nursing has a distinct theoretical orientation to practice.
Based on a specific body of knowledge that is built on theory
Action language
Behaviors: ex: __reaching, pointing, turning_
(Civil War) Phoebe Pember:
Confederate hospital matron
Health Care Disparities
Defined as "differences in the quality of health care provided to different populations" Frequent disparities include: insurance, gender, age, socioeconomic status, disability, culture, ethics Provider bias: is a possible contributing factor. Refer to: ANA online journal OJIN, 8(1), 2003; "Disparities in Health Care: Focusing Efforts to Eliminate Unequal Burdens"
Resilience
Defined as a _successful adaptation___ despite challenges or threats to ones way of life/routine.
Somatic language
Early development: ex: ____crying, reddening skin etc
Use reflection
Encourage clients to think through situations by reflecting their questions back to them to develop their own solutions This helps clarify the clients thoughts.
BSN program
Equips graduates to practice within _complex health care_ systems and to assume multiple nursing roles.
Nursing Process
Evaluation Assessment Analysis of data Nursing care planning Implementation of Care (evaluation)
Perception, evaluation and transmission influenced by:
Gender, age, culture, interest, mood, value, clarity, length of the message Presence or _absence of feedback__ Atmosphere of the context
Dunn (1961):
Health is a continuum with high-level wellness at one end and death at the other
Cultural Assessment
Identify __beliefs__, values__, and _health practices__that may help or hinder nursing interventions. "Stranger in a strange land" Culturally competent nurse: _continuously learning__ _sensitivity_ respect_
Hospice and palliative care
Improve end quality of life, patient comfortable
_______ in nursing is showing a recent upward spiral.
Incivility While difficult to explain, it is crucial to address. Uncivil behaviors range along a continuum.
For-profit Agencies
Include numerous home health care companies, hospital systems, specialty outpatient centers, heart hospitals, and rehabilitation centers Distribute profits earned to shareholders/partner
Community Health Nursing
Increasing as more nursing care is delivered outside hospitals
____________ includes lessons that occur incidentally. This includes unplanned:
Informal socialization observations, new vocabulary, participating in a student nurse association, and hearing nurses discuss patient care_ . __informal experiences_are often the most powerful.
When a patient believes he can help control his cardiac condition by power-walking through his near-by national park, he is utilizing a health belief based on:
Internal locus of control
1899: ICN
International Council of Nurses
(Chicago World's Fair) Leaders
Isabel Hampton Robb: lack of uniformity among nursing schools Lavinia Lloyd Dock Bedford Fenwick
Chronic Illness__: characterized by gradual development of symptoms that are _long-lived___.
It requires ___ongoing medical attention___. Chronic illness may continue for the duration of the person's life. Chronic illnesses have significant social and _economic_ impact.
4-year curriculum with foundational and nursing courses that focus on:
Liberal arts Nursing science and _clinical nursing skills___ Communication Decision Making
Older model of nurse-client relationship assumes that relationship is:
Linear, incremental, trusting, and cooperative
Hospitals vs Medical center:
Med center: bigger than hospitals, services more specific, trauma center
Florence Nightingale: wrote and founded
Notes on Nursing: What It Is & What It Is Not -first nursing training school
Nursing organization governance
Nursing staff organization
stereotyping_
One size does not fit all" Nurses need to create individualized plans sensitive to each culture's needs.
Physician assistants (PA)
Perform many functions of a physician under the direction of a physician.
Medical staff:
Physicians who are either employees of the organization or independent practitioners
Clinical/Applied science
Practical _application of scientific theory_& laws Takes to patient's bedside those findings that may be useful in curing, managing, or preventing diseases or managing symptoms
Not-for-profit Agencies
Profits pay for personnel, improve services, advertise services, provide educational programs, or contribute to the mission of the organization.
Certified nurse midwife (CNM)
Provide women care and assist in child birth- at hospitals, clinics, birthing centers, home birthing, additional training after BSN, independent providers and can provide meds
Verbal language
Repetitive noises and sounds that progress to words, phrases and complete sentences
Perception
Selection, organization, and interpretation of incoming signals into meaningful messages
Cultural awareness:
Self-assessment about biases towards others and exploration about __ones own culture
ANCC is responsible for:
Standards of continuing education (CE) Accreditation of CE programs Transferability of CE from state to state Development of guidelines for states' recognition systems
Stress
Stress is both a common response to illness and an important factor in the development of illness___. The many alterations in lifestyle created by illness tend to cause a great deal of stress. Control can be exerted over the number and types of stressors It is distinguished from anxiety as having an environmental component.
How to cope with "Reality shock"
Take responsibility Carefully select your first job _support system__ Find a mentor Learning more about the profession __SELF CARE__
An organization has a mission. A mission statement specifies:
The __purpose & goals of the organization _Who is served by the organization
Critical thinking requires:
The ability to describe ___how you came to a conclusion____ The ability to _support your argument___ with explicit data and rationales- know the "why"
Implementation:
The actual tasks of the study are conducted Ex: Performing interview/clients filling out survey
Each nursing organization has a mission, defined by its mission statement. A mission statement specifies what? (Select all that apply.)
The purpose of the organization Who is served by the organization
Politics" has two meanings.
The science of _government ; regulation and governing of a nation or state **bigger aspect on us The management of a political party_; the conduct and contest of parties with reference to political measures or administration of public affairs
Theoretical Challenges for Nursing Education, Practice, & Research (cont.)
Theory-based practice occurs when nurses intentionally structure their practice around a particular nursing theory and use it to guide them as they use the nursing process. -Assess, Diagnose, Plan, Implementation, Evaluation Theory provides a systematic way of thinking that guides the decision making process.
Ethical Decision Making
This requires that the nurse make judgements or decisions when two or more of their values are different
Nine provisions accompanied by interpretations (CODE OF ETHICS)
Three describe nurses' values and commitments Three address boundaries of duty and loyalty Three address aspect of duties beyond individual patient encounters
Theoretical Challenges for Nursing Education, Practice, and Research
To continue forward movement in nursing (MSN/PhD) and to improve quality of nursing care, nurses go beyond the generic nursing process and use _theoretical perspectives__ focused on the patient.
Nurses, as well as other professionals, create organizations to work collectively on important issues.
To enhance their work To enhance their community involvement To ensure _continued learning and competence_ and competence To use political action to influence policymakers
Which of the following is the ultimate goal of nursing theory?
To support excellence in practice
Your image of nursing and what it entails will change while you are in nursing school. The overarching goal of nursing education is:
To teach you to _think like a nurse___ To see the world of health care through the __lens of nursing___ To respond to both educational and __clinical_____ experiences by developing professionalism
Leininger's Theory of Culture Care Diversity and Universality (1978, 1991)
Transcultural Nursing Society; Journal of Transpersonal Caring Goal of transcultural nursing involves planning nursing care based on specific knowledge that is culturally defined, classified and tested. Care that is _culturally congruent_ for patients. Transcultural nursing has become increasingly relevant with global migration creating more __diverse societies__.
Critical thinking in nursing involves 4 questions:
What __assumptions__ have I made about this client? How do I know my assumptions are __accurate___? Do I need any additional _information___? How might I look at this situation differently? Begins with __reflective thinking___ Is a complex, purposeful, and disciplined process Supported by the standards and ethics of nursing Improves with ___practice and professional experience___
Nursing informatics:
With BSN (sometimes MSN) help develop charting systems
1993: Vietnam ______ statue was dedicated in DC
Women's Memorial
Elizabeth Tyler
Worked with African American patients at the Henry Street Settlement
NLC does not require _______
application for licensure by endorsement
Physical therapists
assist patients to regain maximum possible physical activity and strength by assessing pre-illness/injury function, current damage, and potential for recovery
Cultural systems
attitudes beliefs, behaviors, attitudes towards health/illness, language, etc.
These systems exacerbate _____ that already exist
basic ethical problems
Occupational and environmental health:
basic health care services, emergency treatment, assessing workers, addressing substance abuse (employee health)
Philosophy:
beliefs about the nature of how the world works. Nursing philosophy ties together the concepts of nursing's metaparadigm
Nursing diagnoses must be supported by
data
_____ and ______ documentation systems have created a digital portal into patient's confidential medical information
digital technologies and electronic health records
close system
does not interact with other systems or the environment.
Illness forces ___, role changes and unpredictable changes in family dynamics.
emotional/behavioral
Shared governance
employees have both a right and a responsibility to govern their own work & time within a financially secure, client-centered system. Responsible for professional practice of their nursing unit by adhering to the standards and benchmarks of quality care.
Johnson & Johnson launched campaign (2002) to
enhance nursing's image & improve recruitment
Cultural encounter:
face to face interaction_ with those from diverse backgrounds.
Social systems
families, neighborhoods, schools, churches, professional associations, civic groups, and recreational groups
Fidelity and Veracity:
fidelity: faithfulness or honoring one's commitments or promises (key foundation for nurse-patient relationships, key for upholding the Code of Ethics for Nurses, key for maintaining competence) veracity: telling the truth: not lying (fundamental to continued trust between people, two exceptions can exist for nurses: if a patient asks to not be told the truth, if a patient is mentally incompetent)
Findings directly related to the research question are presented
first and factually -- without judgments. Accurate presentation of the facts. After findings related to research question are reported, _unexpected findings__ may be reported.
University of Minnesota (1909):
first bachelor's degree program established
Richard Hall, 1968:
five point model of a profession and its uniqueness
(Civil War) Clara Barton
founded American Red Cross
In 2013, more than _____ nurses held licenses and ____ were working
four million, 2.8 million
The Hill Burton Act (1946) provided ______
funds to construct hospitals
Research is generalizable
generalizable (transferable) to other situations.
Nurses are in a prime position for
identifying problems and issues for research_
Involvement in professional organizations is _______
important.
Chief executive officer (CEO)
in charge of the whole organization (but can't make all the decisions on his own)
multiculturalism
includes culturally distinct identities with enjoying full access to society's constitutional principles and prevailing shared values.
State of "normal" health is
indefinable, even though disease may be managed successfully.
Malpractice does not have to be ____
intentional (occurs through commission or omission)
Communication across differing languages: Use professional language interpreters and translators when necessary.
interpreter orally communicate using two languages. Translator works with written documents in two languages.
Writing the plan of care is done once the
interventions___ are selected.
A larger environment
is called the suprasystem
"Middle-range theory"
is defined as _narrower in focus and __makes connections__ between grand theories and nursing practice
"Power "
is defined as the strength or force that is exerted or capable of being exerted.
Defined scope of practice determines what a nurse
legally can and cannot do
All states now have
mandatory licensure for the practice of nursing at the RN and LPN/LVN levels
Flexner Report, 1910: groundbreaking work to reform standards in _______
medical education -published list of criteria characteristics of all professions -has strong influence on nursing education
1950: NLN administered the first ____
nationwide State Board Test Pool Examination
_____: central issue of malpractice
negligence
Remainder of nursing employment:
nursing organizations, schools, of nursing, local, state, or government agencies, insurance companies
Attend to __________ through Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance
patient's privacy/ confidentiality
Professional _____ and _______ distinguish an occupation from a profession
preparation and commitment
Confidentiality protects:
private information about a patient during provision of medical services
US Constitution:
provides balance of powers to establish legal relationships between persons and the government (preamble)
Some chronic illnesses go through
remission and _exacerbation (symptoms worsen)
APNs have worked to change laws to increase their _____
scope of practice
Behaviors may be the client's way of signaling an increased need for
security or support_; independence may not be the desired outcome Both overly dependent and overly independent behavior can be frustrating to nurses.
Nurse entrepreneur:
self-employed, make own business (sell stuff on side)
The regulations governing nursing practice in each state flow from that
state's nurse practice act Regulations are changed from time to time and can negatively affect nursing practice. Nurses must monitor policies that affect their practice, and they must become active in policymaking initiatives to enhance nursing authority and prevent _restrictions on practice__ .
Diseases may be _____ but not _______
treated, cured
Organizing data:
use of a standard framework to sort and organize patient data
Nurse practice act in your state:
usually most important law affecting nursing practice within state bounds
Identify each item as subjective or objective data.
"I cannot stand this food anymore"- subjective Blood pressure of 153/100- objective Facial grimace upon abdominal palpation- objective Fidgeting when family member is present- objective "I have a stabbing pain in my lower back"- subjective Client rates pain at 7/10 on NRS.- subjective
Median salary:
$65,470
Aging of America
-longer life expectancies -higher proportion of older versus young US citizens -new disproportion will create stress on US econ and social systems -profound impact on health care systems including access, delivery, and staffing
School nursing:
1 school nurse for every 740 students is recommended, in charge of illnesses, keep track of illnesses, work alongside doctor, assessing students for neglect, bullying, violence, sex ed
Three mechanisms of nursing education:
1. 4-year BSN (slightly over 50% of nurses) 2. 2-year associate degree in nursing (ADN) (majority of nurses receive initial education through ADN programs) 3. Diploma: typically 3 years of hospital education earned by only 3.1% of nurses since 2004
Bandura identified four components needed for effective program for a lifestyle change:
1. Information 2. Skill development 3. Skill enhancement through guided practice/feedback 4. Social supports for change
Three major consent conditions exists:
1. consent must be voluntary 2. it must be given by the individual with capacity and competence to understand 3. the patient must be provided enough information to be the ultimate decision-maker
All four elements of a cause of action for malpractice must be proved:
1. nurse has assumed duty of care 2. nurse breached the duty by failing standard of care 3. this failure was the proximate cause of the injury 4. the injury was proven
___% of enrolled students are men and in earlier eras they were recruited for strength
11%
NLC has been adopted in ___ states, with ___ more states pending legislation as mid 2015
24, 6
There was a _____ increase in the 2000s (of nurses)
24.1%
Bachelor's of science in nursing mean age
28
In 2015, the American Association of Colleges of Nursings (AACN) stated that ______ of nursing students in entry-level BSN programs were from underrepresented backgrounds
30.1%
Men over-represent certified registered nurse anesthetists (CRNAs) at ____%
41%
Median age has risen from 38 years in 1988 to ____ in 2004, reflecting ____
46yrs economic downturn in which older nurses remain in the workforce
According to the 2008 NSSRN data, ____% if nurses younger than 50 were employed either full or part time and fewer than half of the nurses older than 65 remained working
90%
Social change:
A high degree of change in one's social system can produce illness. (divorce, death, moving...)
Policy
A plan or course of action by a government, political party, or business intended to influence and determine decisions, actions, and other matters. -gives specific map on what to do
Educational credentials of hospital RNs range from
ADN to doctorate (PhD)
Important professional nursing organizations include:
ANA: broad-purpose NSNA: broad-purpose Sigma Theta Tau International (STTI): special interest International Council of Nurses (ICN): broad (Specialty: pediatrics nurses... etc.)
Attitude and respect for others is essential. Key communication elements include:
Active listening Acceptance Being nonjudgmental Conscious use of feedback Appropriateness Efficiency Flexibility
Actively Participating in One's Own Professional Socialization
Actively involving yourself in the _learning process___ Keeping YOUR perspective Setting aside preconceived ideas, prejudices, and habits Opening up your creative side, your abstract, hypothetical thinking Being receptive to feedback Developing __time management__ skills Getting a mentor for emotional support Using faculty members as important resources
The environment includes:
Air, water, organisms and other natural resources Social and cultural
PCC depends on:
Alleviating clients vulnerability is vital to PCC Therapeutic engagement_ _Communication___ as the primary instrument
Evaluation_
Analysis of information received
Nurse managers fulfill nonclinical roles
Assume 24-hour accountability for their units
Educational Preparation for Nurse Practitioners and Assistants to Nurses (ANA, 1965): Studied education, nursing practice, and trends in healthcare resulted in:
BSN education should be the foundation for professional nursing practice. Controversial & fostered conflict and division in nursing.
Provide college education and preparation for licensure after _passing NCLEX-RN___ as well as advanced college education for established RNs.
Bachelor's Degree Programs
Self Awareness
Basic to effective interpersonal relationships
Which nursing theorist identified the five stages of novice to expert?
Benner
124,000 volunteer student nurses were certified by ____
Cadet Nurse Corps (stipend, serve through war)
Great society reforms of President Lyndon B. Johnson fostered the _____
Certified Nurse Practitioner role (CNP)
Advanced practice nursing (APN)
Certified nurse practitioner (CNP)- perform physical assessments, take med history, diagnose & prescribe meds
Do You See Me? By Renee Lick
Clients are treated according to their disease- not human beings worthy of respect and dignity.
Communication across cultures
Clients unwilling to share information because of culture constraints.
Code of Ethics for Nurses With Interpretive Statements (ANA 2010)
Code of ethics: public document reminding nurses & the public of nurses' obligations and responsibilities to patients and others
Cultural skill
Collect relevant cultural data regarding the client's presenting problem
_______ also is an important standard for professional nurses
Collegiality
These organizations provide outlets for keeping up with the latest developments in nursing, through:
Conferences Webcasts Position papers Members-only websites Journals
Data collection:
Data should be collected ONLY by those _thoroughly familiar with the study (meaning those who understand the purpose, collection methods, and analytical plan of the research).
Three categories of beliefs
Descriptive or existential beliefs The sun will come ooooout tomorrrrooowww Evaluative beliefs If something is good or bad Prescriptive (encouraged) and proscriptive (prohibited) beliefs Undesirable or encouraged based on beliefs
American Nurses Association's ANA Model Practice Act (1996)
Developed revisions in states' nurse practice acts
Three options for a nursing education
Diploma program____ 4-year _Bachelor's of science in nursing (BSN)__ degree program 2-year _associate degree in nursing (AND)__-most newly created____
SBNs have the power to discipline a licensee
Discipline is to protect public from dangerous practice
American Civil War: leaders emerge (Dorothea Dix)
Dorothea Dix: mental health advocate, Union appointed her Superintendent of Women Nurses
The Natural Environment
Earthquakes, Hurricanes, Wildfires, Tornados, etc Climate change Lead and mercury poisonings Toxic shellfish Deforestation Destruction of wetlands Waste emissions
Jessie Sleet Scales & Elizabeth Tyler
Established Stillman House -branch of Henry Street Settlement -served African American patients though community health nursing programs -Their courageous activism broke through racial barriers
Transmission_
Expression of information, verbal or nonverbal_
The definition of nursing is universally accepted.
FALSE
Articulated Programs
Facilitate opportunities for nurses to move up _the educational ladder___ LPN ADN BSN MSN -Students may leave education after first year, take the exam for LPN. -LPNs scope of practice located in states nurse practice act__:
Because all nursing diagnoses must be accurate and supported by data, all are equally important for purposes of implementation.
False
Recently, an increase in the number of nursing organizations nationwide has prompted an increase in membership for nurses, with approximately 30% of nurses belonging to at least one organization.
False
National Group for the Classification of Nursing Diagnosis (1973)
First list of nursing diagnoses Now known as NANDA-I; international
Margaret Sanger:
Fought for safe contraception and family planning (dangerous, controversial work) renowned for preserving reproductive and contraceptive rights for women Henry Street Settlement still exists today-serves all ages & variety of health services, social services, & the arts
The early 1980s marked the recognition and spread of the _____
Human immunodeficiency virus (HIV)
International Council of Nurses (ICN)
ICN is a federation of nurses representing more than 13 million nurses in more than 130 countries. ICNs membership is diverse but has similar definition of nursing to ANA and the RCN.
Successful collaboration entails several steps.
Identify those who have stake in the outcome of the collaboration. Identify problem(s) to be solved. Identify barriers to developing a solution Clarify desired outcomes Clarify the process (How will we approach the task?) Identify who will be responsible for each step in the task. Evaluation (Have we met criteria for success?)
Hospitals are traditionally stressful work environments for nurses. This can be reduced by:
Implementation of "caring" groups for nurses Institution and departmental development of vision, mission, and philosophy of caring and support for nurses A caring/healing room with therapy services for nurses Mentoring programs for new graduate nurses Participation in American Nurses Credentialing Center's (ANCC) Magnet Recognition Program®
Mild anxiety
Increased alertness, increased ability to focus, improved concentration, expanded capacity for learning
The nursing profession combines two sources of nursing philosophy
Individual philosophies: developed by each nurse Collective philosophies: developed by schools of nursing and hospitals
According to the text, what is the fourth technological development?
Knowledge
Six components of nursing diagnoses: NANDA-1
Label Definition Related factors Defining characteristics Desired outcomes/evaluation criteria Actions/interventions
Theory:
Latin and Greek word for "a viewing" or contemplating
___________ -first nursing professor in history & conducted The Educational Status of Nursing
Mary Adelaide Nutting Focused on _teaching methods___, material being taught, and __living conditions___of students
Scientific Method
Method-is the systematic way of thinking. Used to discover and test facts and principles
1920: Congress approved____
Military ranking for nurses
Utilitarianism (Hume)
Moral rightness of an action is determined solely by its consequence
AD program
Most common type of nursing education for licensure Typically 24-month or longer curriculum -Popularity because accessibility of community colleges, __low tuition costs__, Part-time and evening study opportunities, _shorter duration of programs__ & eligibility to take licensure Use as a step in __progression toward BSN__ or master's of science in nursing (MSN) Graduates the most RN candidates of all basic programs
Nurses can expect employment opportunities to grow "____" around ____% through 2022
Much faster than average- 19%
Data collection instruments range from simple survey forms to complex radiographic scanning devices.
Must be _reliable, consistently accurate_ Must be valid , must measure what is supposed to be measured Abstract data may require researching for a reliable and valid tool
Military nursing:
Must have BSN, must be 21-46.5 yrs, must have trauma experience
Nurse educators
Must have MSN, have on units of hospital
Researchable problems
Must occur frequently enough to be important and must be amenable to ethical examination. May be replicated or similar to a previous study (FUNDING) Testing theoretical models
1908: NACGN
National Association for Colored Graduate Nurses
Examples of studies that have changed nursing practice
Newborns wearing caps to prevent heat loss Frequent pain medication after surgery Positioning patients after chest surgery to facilitate breathing
Three American schools were modeled after _____
Nightingale's school (they were opened in 1873) -Bellevue Training School for Nurses (NYC) -Connecticut Training School for Nurses (New Haven) -Boston Training School for Nurses at Massachusetts General Hospital
Research vital_ to the future of nursing.
Nurse researchers are increasingly meeting the challenge of using nursing theory to structure nursing research that: Tests theory Develops theory through interpretation of qualitative research
Nurse's role on the health care team: researcher
Nurse researchers integrate research findings into practice. They investigate whether current nursing actions achieve their expected outcomes, what options are available, and how best to provide care. They also look at the nursing process and the systems that support nursing services. Outcomes research has become integral for nurse researchers.
Becoming _Nonjudgmental
Nurses acknowledge all patients' rights to be who they are and express their uniqueness: _nonjudgmental acceptance___ Nurse conveys acceptance to patients, neither approving nor disapproving their personal beliefs, habits, expression of feelings, or lifestyles.
Nurses' Role in Managing Health Care Costs
Nurses play an important role in controlling health care costs. Nurses should become cost conscious. When made aware of costs, supply patterns may change Nurses tend to have poor cost awareness. Nurses can promote cost savings by: Becoming aware of the cost of supplies Reducing waste & questioning labs or unnecessary, repetitive tests Suggest generic drugs over name brands Teach patient and families to monitor health conditions and detect problems early to avoid repeat hospitalizations Prevent patient falls Organize and streamline flow of patients for maximum efficiency Providing excellent patient care
Self disclosure becomes problematic when...
Nurses problems or needs are disclosed Disclosure by the nurse becomes a common event during interactions Nurse relays needs quickly during interaction Nurse discloses information unrelated to patient/interaction
Biomedical (technology)
Nurses take responsibility for monitoring and responding to data generated by complex machines or implantable devices (pacemaker, insulin pump)
Carefully distinguish between nursing and medical diagnoses.
Nursing diagnoses _address patient problems___that nurses may treat within their scope of practice
Holistic nursing care nourishes the _whole person: body, mind, spirit__. Eight factors contribute to a holistic approach to nursing:
Nursing is an open system . Nursing is the provision of health care services that focuses on assisting people in maintaining health, avoiding/minimizing disease, and restoring wellness or achieving a peaceful death. Nursing involves collaborating with clients and families . Nursing is integrally involved at points along the health-illness continuum. Nursing care is provided regardless of diagnosis, differences, or other factors. Nurses require advanced knowledge and skills; they also must care about their clients. Nursing requires concern, compassion, respect, and warmth. Nursing links theory and research to answer difficult questions.
Why is nursing theory important to the profession?
Nursing profession __becomes stronger_when knowledge is based on sound theory. *Theory is a tool for reasoning, critical thinking__& decision making
Code of Ethics for Nurses with Interpretive Statements (ANA 2015)
Nursing profession's expression of its ethical values and duties to the public
Henderson's Theory in practice
Nursing should adopt an orientation to care from the perspective of the 14 basic needs Henderson specified. These are easily applied to a variety of patient care settings. Brief outpatient encounters with a limited number of needs Complex settings where patients are extremely vulnerable Basic needs include: Breathing normally, sleep/rest, need to eliminate bodily waste, communicate, need for work and a sense of accomplishment (pg. 180 Box 9-2)
Team nursing
Nursing teams are composed of staff members with different skill levels assigned to groups of patients depending on skill level of care needed
Dorothea Orem (1959)
Orem's definition hinges on the belief that nurses should do for a person only those things the person cannot do without assistance, emphasizing patient's active role
Dorethea Orem
Orems Concept of self-care (1959) Nursing: Concepts of Practice, published in 2001, discusses three interrelated theories. Theory of self-care Theory of self-care deficit Theory of nursing system Based on the belief people want control of their lives!
Conceptual Models/Framework
Organizational structures for critical thinking about the process of nursing Less abstract, more formalized; "blueprints" Preliminary view of the relationship between concepts of nursing that can be used to build theory.
Curriculum Guide for Schools of Nursing (1937) by NLNE
Outlined 3-year curriculum & influenced the structures of diploma schools
How to solve nursing shortage?
Outsourcing & recruiting younger nurses
Faith community:
Parish nursing: care of spirit, holistic care, work with pastor, work with doctor, care for people at congregation
External Influences on Behavior
Past experiences_ Messages from childhood about illness can affect one's adjustment to it. Nurses should determine the nature of past experiences related to health and care in order to _individualize care accordingly. Culture: pattern of learned behavior and values that are reinforced through social interactions
nurse's role on the health care team: patient advocate
Patient advocate: Supports and tends to clients needs through advocacy, protecting clients rights, and ensuring high-quality treatment to ensures that clients best interests are met. Ex. Strict visiting hours are upsetting client who is healing well. Nurse allows more generous visitation than allowed. Best interest of our clients is our top priority!
Collecting Data:
Patient interview____, ___Physical Examination__, __Consultation_____
_Guilt_
Patients may experience guilt about becoming ill, especially if the illness is linked to lifestyle choices. Inability to perform regular activities
Earliest type of nursing education
Peaked in 1920s & 1930s Approx. 2000 programs existed Allowed avenue for women to obtain formal education & jobs
Locus of control and health-related behaviors Locus of control:
People tend to be influenced by either an internal or external view of control. Internal locus of control: health is internally controlled by _what they do themselves_ Research has said, they feel more responsible for their own health= more amendable to change External locus of control: health is determined by _outside factors__
Three factors of nursing philosophy
Person, health, environment
________ contributes to how a client manages illness.
Personality structure Personality characteristics to consider include:
Factors that affect clients' capacity to learn include:
Physiologic factors Ex: pain, late at night Cultural factors Ex: language barrier, cultural congruency Lack of motivation and readiness Ex: shock stage... denial... external locus of control Environmental factors Ex: making sure there is a private space....
According to Maslow's hierarchy of needs, which is the most basic level of need?
Physiologic survival
Which of the following factors can impact a patient's capacity to learn to cope better with stress due to illness? (Select all that apply.)
Physiology Culture Motivation Environment
By 1879 there were 11 nursing training schools
Programs ranged from 6 months to 2 years and each school had it's own standards/requirements. Students received a diploma at graduation Diploma program originated Purpose of the nurse training schools? -to staff hospitals (more concerned with this)
Primary Nursing
Promote the concept of an identified nurse for every client during the clients stay on a particular unit. The goal is to deliver consistent, comprehensive care by identifying one nurse who is responsible, has authority, and is accountable for the client's nursing care outcomes.
Accreditation promotes adherence to standards that:
Protect _quality of education____ Protect __public safety___ Protect the __nursing profession_____
Philosophies of Nursing:
Provide a broad, general view of nursing that _clarifies values_ and answers broad _disciplinary questions__such as: What is the profession of nursing? What is the nature of human caring? What do nurses do?
Nurse's role on the health care team: provider of care
Provide direct, hands-on care in all health care agencies and settings. Have an active role in: Illness prevention Health promotion Health maintenance Major role of a nurse is ensuring continuity of care through the clients transition from inpatient to outpatient care through coordination of care and discharge teaching.
Royal College of Nursing (RCN)
RCN is the United Kingdom's voice of nursing and the largest professional union of nurses in the world. Their definition has a core statement supported by six defining characteristics. "Nursing is the use of clinical judgement in the provision of care to enable people to improve, maintain or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death" stated by RCN (2015)
Gilligans stages of moral reasoning
Recognizes that women's relational orientation to the world shapes their moral reasoning differently from men's -women focus on care and consideration of responsibility in relationships -men focus on justice
-Brown Report (1948):
Recommended that basic schools of nursing be placed in universities and colleges with efforts to recruit _men__ &__minorities__into nursing.
Certified Registered Nurse Anesthetist (CRNA)
Requires additional 2-3 yrs in MSN program, work independently or report to anesthesiologist
Theory-based research tests and refines the knowledge base of nursing.
Research findings: Enable nurses to improve the quality of care Understand how evidence-based practice influences improved patient outcomes
Research proposals must be submitted to the _Institutional Review Board_ (IRB).
Research is well designed Does not violate the __policies and procedures_ of the institution Does not violate the rights of the _participants_
Which is an aspect of coping that can be defined as a pattern of successful adaptation despite challenging or threatening circumstances?
Resilience
Physicians
Responsible for medical diagnosis and interventions to restore health.
International Council of Nurses (ICN) Code of Ethics for Nursing
Rights and responsibilities of nurses related to people, practice, society, co-workers, and the profession
Nurses must demand and use: (for care of environment)
Safe needle stick devices and disposal containers High-efficiency ventilation systems Alternatives to latex gloves and products Adequate environmental services support Adequate lifting assistance with devices Reduction or elimination of shift rotation and double shifts Appropriate occupational safety and health training Thorough hand washing techniques Personal protective equipment (PPE)
Jessie Sleet Scales
Served the African American community
Translational science
Serves as a conduit between "bench" and "bedside" Takes findings from the laboratory tests for development for use at the bedside__ Then, reverses process to take clinical research done at bedside to ask new questions and direct new research at the bench level
(Spanish American War) typhoid fever epidemic
Set stage for Army Nurse Corps (1901) Navy Nurse Corps (1908)
Chicago World's Fair (1893)
Several nursing leaders emerged after gathering there to share ideas What became the National League for Nursing (NLN) was formed at this meeting
Give _information__
Share appropriate knowledge that clients are not expected to know.
Board of directors
Significant responsibility for the mission of the organization, quality of the serviced provided, & financial stability of the organization.
Adjustment to Illness (stages)
Stage 1: __Disbelief and Denial__ Defense mechanism used to avoid anxiety and fear Stage 2: __Irritability and Anger_ Emotions related to alteration of functioning caused by illness Stage 3: __Attempting to Gain Control___ Fears stimulate treatment-seeking behavior to gain control over the illness. Fears can also lead to further denial and avoidance Stage 4: _Depression (should not expect) and Grief___ Common mood resulting from altered lifestyle, modification of many activities, diminished sense of well-being, and pain A Prayer for Sarah by Kimberle Deller Stage 5: _Acceptance and Participation____ Client has acknowledged the reality of the illness and is ready to participate in decisions about treatment. These stages are descriptive; patients do not move through these states in a linear way.
Benner developed model in 1984 to explore how nurses make the transition to become expert practitioners. Five stages of nursing practice- ch 5 page 96
Stage 1: ____Novice Stage___- entering nursing school, depend on rules and expectations set by nursing program Ex) following strict visiting hours in hospital Stage 2: advanced beginner period- base practice on theory and principle, but experience difficulty with prioritization Ex) difficulty knowing which practice to do first Stage 3: competent practitioner- usually 2-3 years of experience, feel competent, organized, and efficient Stage 4: proficient practitioner- usually 3-5 years experience, when nurses begin to do more holistic assessments on patients, prioritization comes easy, more concerned with patient outcomes than hospital rules Stage 5: Expert practitioner- people with significant experience, often practice without thinking
Who has power to license RN?
State Board of Nursing
Discussion and/or clinical implications:
Suggestion for actions_ that can be taken as a result from research findings. _Replication_ of studies
Supply and demand:
Suppliers provide goods and services; consumers demand and use them. When demand exceeds supply, prices rise. When supply exceeds demand, prices fall.
Professional organizations offer
Support to learn leadership skills __Testing Ideas__ Implementation of ideas to completion
The relationship between client and nurse is the focus of attention, rather than the client only as the unit of attention. Goals of therapeutic interpersonal relationship:
Survival of the client Client's understanding of health problem & learning from these
Patient-centered care
Takes client's values and beliefs into consideration when planning and providing care. Nurses must be a flexible, respectful, and negotiable
reflective practice
Taking time to focus on own thoughts and __feelings and beliefs You cannot control your emotions but you can control your _behavior_
National Council Licensure Examination for Registered Nurses (NCLEX-RN)
Tests critical thinking and nursing competence
AACN approved a position statement;
The Baccalaureate Degree in Nursing as Minimal Preparation for Professional Practice
According to Peplau, there are six roles for a nurse to use in helping the patient achieve personal growth. These goals may be affected by which one of the following?
The ability of the nurse to create an interpersonal relationship
Consequences of Chronic Illness
The consequences are pervasive and life altering . They lead to altered individual functioning and disruption of family life. Long-term medical management can create financial hardship. Clients need to make significant _life changes__ Ex: person with diabetes- new diet, etc Emotional reactions to illness may be greater than the physical challenge.
WWII
The inadequate supply of nurses prompted- Congress to budget for nursing education
A critical definition of nursing for each nurse is contained in the nurse practice act of the state in which the nurse practices.
The legal definition of nursing in a particular state can be found in the STATES Nurse Practice Act
What nursing action demonstrates individualized nursing care?
The nurse assesses for patient's food preferences.
Coping ability
The strategies a person uses to assess and _manage demands With acute illness, coping behaviors are generally _short-term_ and lead to pre-illness state. With chronic disorders, coping behaviors must be used __continuously_ .
Nursing Research
The systematic investigation of phenomena related to improving patient care. Ideas for nursing research arise from clinical observation Problems are appropriate for research and will more likely be funded if: A _conceptual framework exists_ or can be constructed to logically fit with previous knowledge. The proposed research is based on related findings published in _peer-reviewed journals_. Research is carefully designed so results will be applicable in similar situations or generate hypotheses. A manager could encourage RN's to understand that RN's are qualified to do research when they develop a basic understanding of the research process. RN's need to be implementers of research
Ask open-ended questions
These prompt patients to answer fully with more than a "yes" or "no".
Anger
This is a common emotional response due to sacrifices to manage their illness OR towards caregivers due to lack of a cure, ways to reduce pain or prevent negative consequences.
Leininger's contribution to nursing knowledge is related to which idea?
Transcultural nursing and caring
Before Nightingale, men provided most of the nursing care:
True
Critical thinking requires a process of change.
True
In a clinical setting, professional ethics should override personal morals and values
True
UAP (CNA)
Unlicensed workers who are key members of the nursing staff and assist with basic patient care.
Visit an association's website to find out more about its activities. Ask yourself these questions:
What is the mission and purpose of the organization? Is the purpose compatible with my own? What is the number of members nationally, statewide, and locally? What activities are undertaken? How active is the local chapter? What are the opportunities for involvement and leadership? What are the benefits of membership? Are there continuing education programs? Do they lobby for improved health care legislation? Is this a cost-effective membership? Are there benefits for members from legislative agendas and other activities?
Feedback
When a receiver relays to a sender the effect of the sender's message
Appropriateness
When a reply fits the circumstances and matches the message
Voluntary agencies (private) & Nongovernment organizations (NGOs)
Work to promote or restore health through private donations and government grants
______ is that which contributes to the knowledge bases of a discipline
_"Good" science
Conclusions
_Reflective_ about findings, what was anticipated vs what was found and suggesting alternative work to clarify findings
Contracts for unionized nurses include these issues:
_Work hours_ Pay rates _Employee benefits_ Staffing levels Work assignments Shared governance responsibilities
__________ & consulting with professional role models to learn to not impose your own personal beliefs on patients or others
___Becoming aware of your own biases____
Nurses become certified through a
___comprehensive examination__, documentation of experience, letters of reference, and other documents.
Health behaviors:
__choices/habitual actions__ that promote or diminish health Ex: sedentary behavior/lifestyle
Observe _____ among pieces of data.
_correlations/ relationships__
Poverty
a state of deprivation and lack of necessities that leads to diminished access to health care.
Assault:
a threat or attempt to make bodily contact with another without that person's consent
Occasionally the basis for legal action against a nurse defendant:
assault & battery
Beneficence:
based on doing good/ promoting good for others (can be difficult when conflicts develop)
Stress______ our bodies
changes
Nurses have a duty to report certain information, such as ____
child-abuse
The nursing process is dynamic,
continuous moving___ from one phase to another and then beginning the process again.
Health is a _______ as opposed to an absolute state
continuum Health varies from day to day. Illness is not an absolute state; it also can vary from day to day.
Recruitment of foreign-educated RNs is ______
controversial strategy
Goals should be realistic, accessible &
culturally_ congruent.
Professional nursing socialization can be defined as absorbing & assimilating the ______: its rites, rituals, & valued behaviors.
culture of nursing
Negligence:
defined as failure to act as a reasonably prudent person would act in the same circumstances
Houle, 1980:
delineated characteristics that indicate an occupation is moving toward professional status
1935: Social Security Act enhanced ________
enhanced public health nursing
Problem solving is specific to a
given situation & is designed for immediate action__ Provides an effective intervention in one set of circumstances that has immediate application
Nurses should be:
highly educated
As a common framework, a system allows scientists and scholars to
organize and communicate findings, making it easier to build on the work of others.
The nurse examines the
patient's progress
Nurses face two serious ethical challenges in today's sociocultural context:
use of social media and substance use/abuse
Data must be:
validated and compared with norms clustered and grouped
Organized nursing, through the American Nurses Association (ANA), sets forth
value statements that undergird the profession. Published to serve as a resource for nurses about nursing's social responsibility The most recent version is titled "Nursing's Social Policy Statement" (ANA, 2010)
Adjusting to new _______ that may conflict with yours
values
Response to illness
varies widely Individual personality influences illness response.
Human need is something that's required for a person's
well-being.
Peplau's theory is complex, with importance on
what happens between the nurse & patient in the therapeutic relationship More/less time with client depending on the setting_
System is a set of interrelated parts that come together to form a
whole that performs a function
Influence Health Policy at local, state, and national levels
policy makers need a clear understanding of the role & scope of nursing (helps state nurse practice acts reflect the changing roles of a nurse)
You can look to teachers, nursing leaders, friends, and community leaders for inspiration and as role models. You can choose to form a relationship with a
political mentor A mentor is a _role model__ who actively teaches, encourages, and critiques your efforts to learn and act.
Nurses' salaries vary widely according to
practice setting level of education/ preparation & credentials experience region of the country
The most frequent reason for discipline is ______
practicing while impaired
Kohlberg's Stages of moral reasoning
preconventional conventional postconventional
Orlando: In practice, the theory guides interactions toward
predictable outcomes Nurses individualize care for each patient by: Attending to behavior Confirming with the patient ideas and inferences Identifying pressing needs Nurses get to the "bottom line" more quickly when observing, listening to, and confirming along with patient
Pharmacists
prepare and dispense medications, instruct patients and health workers about medications, monitor use of controlled substances, and work to reduce medication errors
Substance Abuse:
presents dilemma for nurses who suspect a colleague is impaired from substance abuse states/employers/nursing associations have plans and information to assist nurses to get help From ANA code "to report illegal, incompetent, or impaired
Diagnoses are written as the
problem/diagnosis related to (r/t) factor/cause as evidence by (AEB) _data/observations____. Ineffective airway clearance r/t fatigue AEB dyspnea at rest
Identify one or more ______ responsive to nursing intervention.
problems These problems are characterized as __nursing diagnoses___.
"Influence" is defined as an action or _________ on the actions, behavior, and opinions of others
process of producing Influence is a form of power that is not legitimated through official channels.
Nurses' personal philosophies interact with their philosophies of nursing and influence their
professional behaviors
When personal values are in conflict with professional values
professional ethics outweigh personal ethics in a professional setting -nurses should find work in which personal ethics are not routinely challenged
Courses/programs are reviewed by
professional nursing organizations. -ACEN, ...
"A Nurse's Guide to the Use of Social Media" by NCSBN (2011)
professional obligation with important ethical and legal ramifications
Nurses' personal and professional philosophies both develop as their
professional practice matures
Nursing requires students to internalize new knowledge, skills, attitudes, behaviors, values, and ethical standards into their own __professional identity___. The process is known as _______
professional socialization
An open system
promotes exchange_ of matter, energy, and information with other systems and the environment.
Those in positions to access health care information share a great responsibility to ______
protect patient information from unauthorized use
Nurses are not usually protected by statutorily _______
protected privileged communications -nurses may be ordered to share information without patient consent (abuse, neglect, infectious disease... )
Permissive law:
protects use of the title, but does not prohibit practice if people do not use the title
Definitions Focus Educational Curricula and Research Agendas
provide a foundation for curriculum development
FNS became the first demonstration of nurses:
providing primary health care
Work settings include ______
public health or private agencies (deliver care for chronic health problems, improve overall community health through programs in prevention, nutrition, child care, heath maintenance
The primary purpose of licensing is to protect _____
public health safety and welfare (CEUs)
Dissemination:
publication and presentation of findings_ so that others can learn from the work that was done Dissemination of findings involves: _Publication_ of findings in a journal of nursing Manuscript reviewed by peers _Oral Presentation_ of findings at nursing research conferences Poster presentation at conferences
Definitions clarify ____ and ____ of nursing
purposes and functions (important for the public, other health care providers, policy makers, journalists to know what nurses do)
Development of verbal and nonverbal communication depends on
quantity___ and __quality_ of stimulation.
(information medical technologies) The goals are to improve:
recording, transmission, access, and continuity of medical information, with goal to "go paperless"
Self-mastery:
reduces feelings of despair and _helplessness_
Metaparadigm:
refers to the most abstract aspect of the structure of nursing knowledge. Consists of the 4 major concepts of nursing: __person, environment, health, and nursing_
HIPAA ____ that all health care providers and their assistants ensure patients' ________
requires privacy/confidentiality
Mandatory law:
requires licensure
Data collection protocol is the data collection procedure
requiring strict adherence to a plan . Must be clear and used by everyone collecting data for the study
Global initiatives for HIV included
research for treatment, prevention, and services in resource-poor nations, especially Africa
Qualitative
research involves exploration of experience, described and interpreted by the researcher. Manipulation of variables and statistical analysis are not done. GOAL: Systematic & detailed description and interpretation of phenomena are the goals
Quantitative
research involves standardized experimental designs driven by hypotheses, measurable variables and outcomes, and statistical analyses
The nurse measures progress against goals and outcome criteria to determine whether problem is:
resolved___ being resolved (in the process of)___ unresolved____
_____ for people is the primary ethical responsibility of nurses in practice
respect
Important for nurses to take ______ for public image and to be aware of portrayals in the media
responsibility
Adjusting to new _____ and _________ -anxiety/disillusionment
roles expectations
A nurse's primary legal and ethical consideration is ___ and ___ care for patients
safe & ethical
The need for increased roles for APNs has been validated by research in the following areas
safety cost-efficiency high level of patient acceptance
Internal causes: (nursing shortage)
salary issues, long hours, increased responsibility for unlicensed workers, too little authority for RNs
2010: Affordable Care Act (ACA)
signed by Obama Provides implementation of health insurance coverage changes to improve access and affordability
Iraq & Afghanistan: Many soldiers return to United States w/ ______
significant injuries
SBAR:
situation background assessment recommendation
The rate of agin working nurses has ______ due to
slowed, due to rise in number of nurses under 30 because of the increased number of nurses aged 60 and older who continue to work in this economy
Code of Ethics:
social contract through which the profession informs society of the principles and rules by which it functions
Students should not be used to
staff hospitals
______ for nursing practice should be established
standards
All nursing programs require approval by the
state board of nursing____.
Proposition:
statements that describe linkages between concepts and are more prescriptive
Gender role ____ starts early
stereotyping
Incivility occurs when people are __________
stressed or feel powerless. "Incivility in the workplace has implications for nurses, patients, and health care organizations, with poor communication and unprofessional behaviors negatively affecting patient outcomes and safety" says Luparell (2011). Treating everyone with respect is a core value of nursing.
Bixler & Bixler (1945):
studied nursing's status as a profession
Aesthetics:
study of beauty and the reasoning behind judgments about beauty
Logic:
study of proper and improper methods of reasoning
Ethics:
study of standards of conduct
Politics:
study of the regulation and control of people as they live in society
Epistemology:
study of the theory of knowledge itself
Metaphysics:
study of the ultimate nature of existence, reality, human experience, and the universe
Shared experiences of particular illnesses creates _____ of patients who can communicate via global, online technologies
subgroups
Two types of data
subjective data__: obtained through patient's description of needs, feelings, strengths & perceptions of the problem; called _symptoms__ Example: "I am in so much pain" or "My heart is racing" __Objective data___: obtained through observation and examination or consultation with other health care providers; called _signs__ Example: Pulse/blood pressure or Facial grimace when palpating abdomen
Accreditation is a supplementary, voluntary review process.
supplementary, voluntary review process.
The ultimate goal of nursing theory is to
support excellence in practice_
The essence of collegiality includes:
supportive and healthy work environment cooperation recognition of interdependence among members of the nursing profession
Patient Self-Determination Act (1991)
supports ethical principle of autonomy uses advanced directives
Virtue Ethics- tendencies to act, feel, and make judgements ___________ as well as through appropriate training
that come from natural tendencies
Politics is a process
that influences the allocation of scarce resources. Examples: money, people, housing needs, equipment, supplies
Regulations are developed to guide
the implementation of legislation.
Belief:
the intellectual acceptance of something as true or correct. Can be described as a conviction.
Philosophy is defined as
the study of the principles underlying conduct, thought, and the nature of the universe; a search for meaning in the universe.
Two distinct problems when using social media:
the transmission of potentially identifiable patient information blurring of professional and personal boundaries
Family systems:
the way a family functions within environmental influences Ex: Children who are nurtured younger Family background may shape one's adulthood, but is not determinative. Nuclear(parents & children)/extended families: children are nurtured by their own parents as well as extended relatives
Clients are more likely to demonstrate behaviors
their caregiver also engages in
Philosophies of nursing are statements of beliefs & expressions of values in nursing that are used as bases for
thinking and acting
Communication is the exchange of
thoughts , ideas, or _information_ and is at the heart of all relationships.
Lack of capacity in nursing schools due to
to insufficient numbers of faculty, clinical sites or other resources. __aging population__increasing needs for nurses
Informed consent must entail a comprehensive set of information about ______
treatment, risks, side effects, benefits, costs, and alternatives
Henderson:
"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 a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge." (1966) She defined nursing and specified the role of the nurse in relation to the patient; a helper/substitute . She linked her definition of nursing that emphasized the functions of the nurse with a list of basic patient needs that are the focus of nursing care.
Paul and Elder (2015)
"____Critical thinking ____ is that mode of thinking- about any subject, content, or problem- in which the thinker improves the quality of their thinking __by taking charge of the structures inherent in thinking and imposing intellectual standards upon them" (Black, 2017, p 214)
Occupation
"a person's regular work or profession... job or principal activity"
The Truth about Nursing (2001) is a nonprofit organization with goal to
"change how world thinks about nursing" -uses a variety of social media to share public image
The Truth About Nursing is a campaign dedicated to
"changing how the world thinks about nursing." We must respond to both good & bad images of nursing.
Evidence-based practice (EBP) is defined as a approach to the delivery of health care that
"integrates the _best evidence from [research] studies and patient care data with clinical expertise and patient preferences_ and values" (Melnyk et al., 2009). In nursing, EBP requires that you be aware of research that supports specific intervention (Alfaro-LeFevre, 2006) Focusing on evidence of effective interventions prevents practice from deteriorating into routine or traditional care based on "what has always been done" without concern for advances in care.
Overtime, frequent imbalances in nursing supply lead to ____
"nursing shortage"
Knowledge: Technology
"technology of the mind" involves use of computer systems to transform information into knowledge and generate new knowledge- called "expert systems"
Highest 10% (salary)
$94,720 (in employment services, general medical/surgical hospitals)
Technologists
(X-ray) assist in the diagnosis of patient problems and obtain and handle patient specimens to be examined for abnormalities.
Two requirements of malpractice action:
-Nurse practices with specialized knowledge and skills -through this practice, nurse caused patient's injury
Society's image of nurses varies:
-They are often presented as sexualized and less intelligent than physicians with relatively simple responsibilities There's also a very positive image: They're highest in honesty and ethics
Model for ethical decision making
-clarify the ethical making -gather additional data -identify options -make a decision -act -evaluate/assess
Consumers of health care are increasingly demanding to have a voice in their healthcare decisions
-number of special interest groups have developed to support patient rights the 1971 United Nations resolution: "declaration of the rights of mentally retarded persons is an early model". The 1990 Americans with Disabilities Act (amended 2008) recognize the rights of those w/ disabilities to participate fully in all aspects of society -"The Patient Care Partnership"
Major issues involved include (ethical dilemmas)
-personal value systems -peers' and other professionals' behaviors -patients rights -institutional and societal issues -patient data access issues -global dilemmas
(US) Diversity trends
-population of most minority ethnic/racial groups is growing in the US including hispanic, Asian, and Native-American people -nursing much change through education and experience to meet differing cultural needs of patients
Preventing legal problems in nursing practice
-practice in safe setting -nurse to patient ratio, benefits, legal coverage -communicate with other health professionals, patients, families -meet standards of care -carry and understand professional liability insurance -promote positive, interpersonal relationships
What is the most common reason nurses are disciplined by state boards of nursing
-practicing while impaired
There are five rights to ensure safe delegation of tasks to unlicensed assistive personnel: (UAPs)
-right task -right circumstances -right person -right direction/communication -right supervision/evaluation
"The Patient Care Partnership" (2003)
-safeguard patient rights -calls hospitals to abide by patients' advance directives -describes what patients can and should expect in the hospital setting
The Vietnam War impacted nursing through:
-stretching boundaries of nursing practice in jungle mobile hospital units -responsibility for performance of emergency procedures -nurses suffered post traumatic stress disorder (PTSD) due to traumas of battlefield roles
Stable supply of RNs: four major initiatives:
1. American Recovery and Reinvestment Act (2009) -to stimulate US economy with provision for $500 million to strengthen to US health care work force 2. Robert Wood Johnson Foundation -Has committed tens of million of dollars to create regional workforce development systems in nursing schools, hospitals, and other agencies 3. Johnson & Johnson Campaign for Nursing's Future -In partnership with National Student Nurses Association (NSNA) NLN, ANA, Sigma Theta Tau International (STTI) 4. American Nurses Credentialing Center (ANCC) Magnet Recognition Program -to attract and retain nurses in acute hospital settings
Maslow's hierarchy rests on basic assumptions about human needs:
1. Basic needs must be at least partially satisfied before higher-order needs become relevant. Ex: grocery store 2. Individuals meet their needs in different ways_. Ex: sleep... A nurse must determine a person's perceptions of his/her needs to provide individualized care__.
Since the ANA is the official voice of nursing, it is expected to be responsible for which of the following? (Select all that apply.)
1. Code of ethics *** 2. Articulation of nursing's social policy *** 3. Position papers *** 4. Contributions to political candidates ***
As the profession of nursing prepares for the future the ANA has developed four basic beliefs that should be included in nurses agenda. These four basic beliefs include which of the following? (select all that apply)
1. Health care is a basic human right and universal access should be provided *** 3. Development and implementation of health policies*** 5. Adoption of a single-payer health care system ***
Three distinct purposes of the Code of Ethics
1. Statement of the "ethical values, obligations, duties, and professional ideas of nurses individually and collectively 2. It is nursing's "non-negotiable ethical standard" 3. It expresses "nursing's own understanding of its commitment to society"
Nurse Practice Act: 4 objectives
1. defines practice of professional nursing 2. Sets educational and other requirements for licensure 3. determines legal titles and abbreviations 4. provides for disciplinary action
SIX major causes of negligence
1. failure to follow standards of care 2. failure to use equipment in a responsible manner 3. failure to communicate 4. failure to document 5. failure to assess and monitor 6. failure to act as a patient advocate
Eight spokes of professionalism
1. professional organization 2. self-regulatory autonomy 3. research: development, use, evaluation 4. continuing education, competence 5. community service orientation 6. theory, development, use, evaluation 7. adherence to code for nurses 8. publication and communication
Lucie Kelly, RN, PhD, FAAN, 1981: eight characteristics of the nursing profession:
1. vital to humanity and welfare of society 2. special body of knowledge enlarges over time 3. services involve intellectual activities 4. education in institutions of higher learning 5. practitioners relatively independent 6. motivated by service and importance of work 7. code of ethics to guide practice 8. organization (association) supports high practice standards
____ of nurses licensed between 2010 & 2013 were men
11%
Men compromised _____ of students in entry level BSN programs in 2014
11.7%
____% of RNs are members of unions or are covered by union contracts
21%
Associate and diploma degree mean age
33
Minorities make up ____ of the U.S. population but only ____ of RN population
37%, 19% (improvement from 2004 when 12.2% RNS constituted ethnic minorities)
Extended care and nursing homes: ___% of nurses
5.3%
Dominated by women, the percentage of male nurses increased by ____ between 2000 & 2008
50%
Nurses receive 1 credit hour of CE per
50-60 minutes they spend in a CE course
____% of RNs have BSN or higher
55
Hospitals remain primary work site at ____%
63%
___% of nurses are males
7%
Community health/public health: ___% of nurses
7.8%
Cultural knowledge:
: Accurate information about the different cultural/ethnic groups
Evaluation is critical;
; it identifies changes that need to be made to resolve the problem or meet outcomes goals.
Current agency that serves as an important source of funding for nursing research
= National Institute of Nursing Research (NINR)
King:
A Theory for Nursing Systems, Concepts, Process (1981) Focuses on people, their interpersonal relationships, and their social contexts Referred to as the personal, the interpersonal system, and the social system Unique focusing on viewing people from the perspective of their interactions.
Social support:
A person belongs to a social network and can count on others for assistance and give assistance to others. -support groups
There are two ways to ensure maintenance of quality standards.
Accreditation of health care agencies takes place through one of two accrediting bodies approved by the Centers for Medicare and Medicaid Services (CMS) a. The Joint Commission: not-for-profit organization serving as the nation's predominant standard-setting and accrediting body in health care. b. Healthcare Facilities Accreditation Program (HFAP) authorized by the CMS. 2. Continuous quality improvement/total quality management (CQI) An internal way for organizations to improve patient outcomes Use employees from many departments to decide how care will be provided, what outcomes are desired, and design appropriate systems Purpose of QI is to focus on establishing procedures for ensuring high-quality client care Performance improvement (PI)- describes organizational efforts to improve corporate performance.
_______ based on a person's changing needs is important for nurses to remember.
Adaptation
Discrimination in early training
Against male, African-American and Jewish applicants
Case Managers
Allow nurse to oversee a patient's care & manage the delivery of services from all health care disciplines throughout a patient's illness (Ex. Elderly patient with recent total health replacement) Internal versus external models of care used Critical path (or a interdisciplinary agreement) shows who will provide care in a given time frame to achieve agreed-upon outcomes
1896: ANA
American Nurses Association (ANA) founded by Isabel Hampton Robb
Funding agencies include:
American Nurses Foundation Sigma Theta Tau International (STTI) Clinical specialty nursing organizations State and local nursing associations Universities, schools of nursing, and _large hospitals_ Other agencies and organizations
Review of Literature
An ROL is a comprehensive exploration of all _relevant research_ and _supporting documents_ to support the research. An ROL asks, "What have other researchers and theorists written about this problem?" An ROL is essential to locate similar or related studies on which a new study can build. An ROL helps to create a _conceptual framework on which to base the study. Literature published with the past _FIVE YEARS_ is adequate
Deontology (Kant)
An act is moral if its motives or intentions are good, regardless of outcome
Certification is possible at different education levels:
An advanced practice nurse: APRN, BC Bachelor's degree: RN, BC or RN,
Orem's Model in practice
Appropriate care for the patients is developed through a series of three operations: Diagnostic : Establishment of the nurse-patient relationship; assess ability to provide adequate self care _Prescriptive: Self-care requisites are determined and nurse reviews various methods, actions, and priorities with the patient. Regulatory: Nurse designs, plans, and produces a system for care. Range from wholly compensatory care to supportive-educative .
The International Council of Nurses adopted Henderson's definition (1960)
Assist (using education) the individual, sick or well, in the performance of those activities contributing to health or its recovery. This definition has been widely accepted in the United States and worldwide. Many believe it remains that most comprehensive and appropriate definition of nursing in existence.
Illness prevention
Assist patients in reducing the impact of risk factors identified through family history and genetic predispositions. Promotion: requires client participation Prevention: addresses health problems, Ex: Pregnant lady brain aneurism
Which one of nursing leader Dr. Lucie Kelly's characteristics of a profession is described as an organization that encourages and supports high standards of practice?
Association
American Civil War:
At start, no nurses could serve As war continued, women responded to needs of sick and wounded by volunteering as nurses (catholic church most involved)
First school exclusively for African Americans
Atlanta Baptists Female Seminary (later Spelman college)
Diversity creates opportunities for nurses to develop skill in transcultural communication. Sensitivity to differences entails:
Attention to age and _experience___ Attention to cultural, racial, and ethnic distinctions Attention to differing levels of abilities Attention to gender and sexual orientation Attention to patients from different countries of origin
Six ethical principles
Autonomy: individuals have the right to determine their own actions & have freedom to make their own decisions Beneficence- the doing of good Nonmaleficence- duty to do no harm Justice- equals should be treated the same and unequals should be treated differently Fidelity- faithfulness/honoring one's commitments or promises Veracity- telling the truth or not lying
From 2004-2012, the number of nurses enrolled in _____ programs almost tripled from 35,000 to approx. 105,000
BSN
Theory-based education (BSN)
BSN students introduced to research process, EBP & use of theory Utilization & application of nursing theory as a guide for practice It is important for students to understand that their coursework is based on a philosophy or a conceptual model that shapes the way nursing is taught. BSN education includes the basics to guide nursing research
Requirements for masters education:
BSN___ degree from accredited program, licensure as RN, minimum undergraduate _GPA of 3.0___, recent work experience as an RN in area related to desired specialty, and _specific goals_ for graduate study. Prepares for roles such as administration, case management, informatics, health policy, health care systems, education, clinical nurse specialist, NP, CNM, CRNA, MSN/MBA and more.
The ACA includes:
Banning lifetime coverage limits for extreme medical conditions Young adult coverage to age 26 Prevention of coverage denial to children under 19 with preexisting conditions Coverage of preventative services Right to appeal coverage decisions Choice of primary care providers
Miller's Wheel of Professionalism, 1985
Based on common themes in work of sociologists & nursing leaders and statements from Nursing's Social Policy Statement and Code of Ethics for Nurses Eight spokes represent other behaviors deemed necessary to maintain or increase nurses' professionalism
Because regulations developed from legislation can change from time to time to affect nursing practice, nurses need to do what? (Select all that apply.)
Be active in politics to help prevent regulations from negatively impacting nursing Monitor own state's nurse practice act to keep track of regulations that impact personal practice Be knowledgeable about the specific contents of own state's scope of practice for nursing
States recognize licensure awarded in other states BUT
Because NCLEX is national exam RNs may practice in different states without repeating the licensing exam BUT nurses must submit proof of licensure in another state and pay licensure fee to receive license in new state
History of Health Care Finance
Before 1945, more than 90% of Americans paid directly from their own pockets or depended on charity. After World War II, most industrialized countries began publicly financed health care systems while the U.S. continued the private, fee-for-service system. U.S. health care costs have skyrocketed due to providers and suppliers finding lucrative loopholes to drive costs up. Population growth and an increased proportion of elderly and chronically ill have further driven up costs.
silence
Being quietly "present" with clients conveys respect for their feelings under troublesome circumstances.
"__Famous Trio_" of first U.S. nursing schools in 1872
Bellevue Hospital in NY, New England Hospital for Women & Children in New Haven CT and Massachusetts General Hospital in Boston, MA Programs of study were 1 year long
National, state and local associations/groups that are classified into three main types:
Broad-purpose professional associations Specialty practice associations Special interest associations
LPN/LVNs
Care for patients under the direction of RNs and physicians, providing basic bedside care.
Leininger's Theory in Practice:
Care is the essence of nursing. Patients must be viewed in the context of own culture to order to provide good care. Begin by: Respecting the culture of the client Plan nursing care recognizing the health beliefs & folk practices of clients culture Nursing care is focused on _cultural presevation_ Nursing care is focused on culture care through preservation, accommodations & repatterning. The proven outcome is increased health and well-being for the patient.
Primary care services
Care rendered at the point at which a client first enters the health care system Primary Care is provided in physician's office, various clinics, or ED Goals of primary health care: 1) Entry into the healthcare system, emergency care, health maintenance, management of long-term & chronic conditions, treatment of temporary health problems
Infection increases blood glucose level.
Change in metabolic system
Depressed affect due to diagnosis.
Change in psychological system
Marty Johnson 55 yo with type 1 diabetes diagnosed with gangrene.
Change in subsystem
Marty is hospitalized for 5 days for IV antibiotics.
Change in suprasystem
Nursing staff
Chief Nurse Officer (CNO) (or chief nurse executive, vice president for nursing or director of nursing) CNO often are members of the board of directors, as contributors to broad decision making for the organization. CNOs are responsible for overseeing all of the nursing care provided in the institution. All registered nurses (RNs) licensed practical /vocational nurses, (LPNs/LVNs), unlicensed assistive personnel (UAP)are included.
Label each of the following goals as short term or long term.
Client will loose 20 pounds in the next three months.-long term Client will walk 20 ft twice a day for the next week.- short term Clients pain will remain below a 3 until the end of shift.- short term Client will completely quit smoking.- long term Client will be able to tolerate meal by second day postop.-short term
Client _education
Clients know best options for treatment, diagnostic tests/procedures they will have desire to participate with physicians in making choices. Emotional support
Dependence/Independence
Clients vary along a continuum in their response to illness. Some adopt a passive attitude and _over rely_ on others to care for them. Others continue denial and try to live as independently as before becoming sick. Most function between these two extremes.
Research ideas are generated from three sources.
Clinical _practice/problems__ _Literature_ - replication of prior research Theory_ - testing nursing theory
What is the nursing profession's expression of its ethical values and duties to the public?
Code of Ethics for Nurses with Interpretive Statements
ANA is responsible for: (voice of nursing, main )
Code of ethics Scope and standards of care (in SNPA) Political action committee (PAC) reach out to legislators Position papers Political candidate contributions
nurse's role on the health care team: collaborator
Collaboration is essential for nurses due to large interdisciplinary team caring for clients. It is vital for nurses to ensure that everyone agrees on the same patient outcomes. Collaborating with patients and families is another important component of this role.
There are three major types of American laws:
Common law-judges ruling become law Statutory: has particular importance for nurses Administrative law: delegate authority
Panic__
Complete disorganization, difficulty differentiating reality from unreality, constant random movements, unable to function without assistance
National Council of State Boards of Nursing (NCSBN) Model Nurse Practice Act and Model Nursing Administration Rules (2012)
Comprehensive documents to guide individual states in developing and revising their nurse practice acts
Moderate Anxiety
Concentration limited to one thing, increased body movement, rapid speech, subjective awareness of discomfort
The data analysis plan determines the process followed for analyzing the data after it is collected.
Consultation with a statistician or a qualitative research expert will ensure a well-designed analysis plan.
Principles of a free-market economy
Consumption of any good or service is determined by an individual's ability to pay. In a pure free-market economy, services are provided to those who can pay.
The exchange of energy and information within open systems and between open systems and their suprasystems is
Continuous
Coping with stress
Coping can be direct: Identify situations that can be __changed and take responsibility for changing them__. Coping can be indirect: Reduce the affective and physiologic disturbances resulting from stress. Use _problem-solving skills_ Plan how to eliminate, avoid, and reduce stress. Use education_ Patients will feel more masterful and less stressed. Patient and family education is a high-priority nursing intervention.
Peplau: The process involves six roles of the nurse in order to complete this process:
Counselor when they get a bad diagnosis Resource questions about diagnosis Teacher educate patient on wound care... devices Technical expert when they need to learn how to use a machine they're hooked up to, IV, charting, pumps Surrogate assisting them in transitioning them to be moms... Leader patient is listening to you...
Nurses are required to be culturally competent in providing patient-centered care.
Cultural competence: _attitudes, knowledge, and skills necessary to provide _quality care to diverse populations
Data analysis:
Data will be analyzed exactly as proposed when the study goes well. Nurse researchers have the final word on what interpretations are made from the data. Difficulty with qualitative research?
Florence Nightingale: historical context
Daughter of privileged aristocratic family (women took care of sick) Stifled by social position, entered nurses training at 30yrs Crimean War (1853-56)
spirituality_
Defined as belief in a higher power, interconnectedness among living beings, and an awareness of life's purpose and meaning Religion differs from spirituality. Spiritual beliefs may have psychological , medical, and financial benefits that are scientifically proven in the future. Increase in chaplain presence in health care settings.
Anxiety_
Defined as diffuse feeling of apprehension and uncertainty Occurs as a result of some threat to an individual's selfhood, self-esteem, or identity Symptoms of anxiety include the physiologic, emotional, and cognitive. S/S: fidgety, sweating, increased heart rate, hyperventilation, less sleeping, nauseous, irritable, crying, depression
ethnocentricism
Defined as the inclination to view one's own cultural group as the standard by which to judge the value of other cultural groups Nurses need to identify the ways personal beliefs and expectations can influence care.
Union affiliation is highly complex.
Defined by rules and regulations under the National Labor Act Overseen by the National Labor Relations Board Nurses join to have control over practice and workplace, to work collectively, and to work to equalize power between management and staff.
Hildegard Peplau (1952)
Defined nursing in interpersonal terms reinforcing the patient is an active collaborator in his or her care She stated nursing is a significant therapeutic & interpersonal process
Scope of Standards of Practice (ANA 2010)
Defines standards of practice & standards of professional performance
American Nurses Association (ANA)
Definition includes six essential features of contemporary nursing practice (Black p 90). Wide scope of practice defined in the preface of the Code of Ethics: "Nursing encompasses the _prevention__ of illness, the alleviation of ___suffering __, and the protection, promotion, and restoration of _health__ in the care of individuals, families, groups, and communities" stated by ANA (2015, p. 10).
Participants must sign an informed consent that explains
Details of the study What participation means Any risks involved No one can be _pressured_ Confidentiality must be ensured _Voluntary__
A variety of benefits from membership in professional associations. Including:
Developing leadership skills (presentations... research... etc) Certification & continuing education Political activism (NP practicing on own... make sure she is reimbursed) Opportunities to define practice standards, take positions on practice issues, and develop ethical guidelines Opportunities to engage in research projects Opportunities for networking with peers Group-sponsored services for individual nurses -Access to journals, jobs, newsletters; travel discounts; products; professional liability insurance programs; group health insurance programs
The nursing process is a systematic, problem-solving approach that provides the framework for nursing practice in the United States and Canada. Put the five steps of the nursing process in order.
Diagnosis- 2 Implementation- 4 Planning- 3 Assessment- 1 Evaluation- 5
Clinical nurse specialist (CNS)
Different settings, wide range of responsibilities, usually experts in a field, can deliver treatment
Some new nurses "drop out" at this point, in any of several ways:
Disengaging_ mentally and emotionally Driving oneself and others to the ___breaking point__ "Job hopping" Prematurely returning to _school___ Burning out (emotionally exhaustive) Leaving the nursing profession entirely
Resilience can be a result of three factors
Disposition : temperament, personality, overall health Family Factors : warmth, support, organization Outside support factors : supportive network, success in school or work
Stressors include:
Disrupted functioning of the entire family Uncertainty about _how to treat the ill family members Anxiety, anger, guilt, depression at having to take over responsibilities of ill member Withdrawal from other family members _Caregiver stress_: common in families of patients with prolonged, progressive illnesses
_________ is a new factor influencing socialization that is becoming more common.
Distance Learning It is a fast-growing phenomenon in nursing schools and hospital settings. "Millennials" The entire curriculum is available online in many educational settings. There is a growing question about whether professional socialization can be developed using online education. Additional research is needed to learn how best to incorporate socialization into distance learning.
Rokeach (1973) made several assertions about the nature of human values:
Each person has a relatively small number of values. All human beings, regardless of location/culture, possess basically the same values to differing degrees. People organize their values into systems. People develop values in response to culture, society, and individual personality traits. Most behaviors are manifestations/consequences of human values. People with unclear values may lack direction, persistence & decision-making skills. Therefore, nurses MUST have values.
Watson
Emphasized a return to earlier values of nursing__ and emphasized the _caring aspects_of nursing Founded the Center for Human Caring at the University of Colorado Proposed 10 "carative factors" (caritas processes) to differentiate nursing from medicine 10 carative factors include: Developing helping-trusting-caring relationships; instill faith, hope & honor in others; assist with basic physical, emotional, and spiritual human needs
_______ believe the environmental decline is causing an increase in certain diseases. Climate change
Epidemiologists Emerging diseases and multidrug resistant strains (MDRS) of organisms will increasingly challenge health care resources. (cancers and respiratory diseases are linked to this) Overpopulation also contributes to the deterioration of the world's environment. Not enough recourses
Henry Street Settlement
Established in NYC (1893) Founded by Lillian Wald Purpose: address serious health conditions of immigrants (first public health nursing) Service: visiting nurses, well-baby clinics, disease prevention, health education, minor illness treatment
Health beliefs model (Rosenstock, 1966, 1990) includes three components:
Evaluation of one's vulnerability to a condition and the seriousness of that condition Evaluation of how effective the health maintenance behavior might be The presence of a trigger that precipitates the health maintenance behavior The model helps determine why some people change their health behaviors whereas others do not.
Excellent type of research to explore patients' experience through "field work"
Examples: Fatigue r/t HIV, responses to intimate partner violence, or elderly's adjustment to living in a nursing home
Price sensitivity
Exchanging medical care for goods/services Third-party payment- removed the concern from consumers because they pay a small portion of the actual costs.
Talcott Parsons (1964) identified five attributes of the White American sick role.
Exemption from social responsibilities Cannot be expected to care for himself/herself Should want to get well Should seek _medical advice___ Should cooperate with the medical experts This definition includes behavior that is dependent, passive, and submissive.
Benefits from using theory in practice:
Explain your practice__ to other health care team members Facilities the transmission of nursing knowledge to you as students Contributes to professional _autonomy___ Develops your analytical skills, challenges your thinking, & clarifies values/assumptions.
Prevent the following failures
Failure to see the uniquness of each individual Caused by preconceived ideas, prejudices, and stereotypes Failure to recognize __levels of meaning___ Must learn to respond to symbolic communication that lies under overt meaning Using value statements and _Cliches_____ Indicates nurse has made a judgment from own framework without considering that client may feel differently Giving __false reassurance___ Provides only temporary support, but does not help the client _failing to clarify_____ Leads to confusion and misinterpretation
Research is the same as problem solving
False
The upward spiraling of incidents of incivility in nursing is readily explained by pressure on nurses to increase their workload.
False *** occurs for many different reasons
Transformations in our health care system have led to restricted roles for nurses.
False *** our roles our increasing
Homeostasis maintains balance within a system. Homeostasis does not occur between different systems.
False -everything works well in conjuction with each other
President Obama signed the ACA to ensure that a systematic and comprehensive reform of the entire health care system will take place for citizens of the United States.
False***
Disease management services are provided primarily to help patients manage acute illnesses in their own homes, eliminating the need for costly hospitalization.
False*** (chronic)
In the early days of diploma and hospital-based nursing programs, what was one of their primary contributions for women in society? (select all that apply)
Fill the nursing shortage across the country Staff the hospital by trained workers Provide an avenue for formal education and jobs
Who published Notes on Nursing: What It Is and What It Is Not?
Florence Nightingale
______ is credited with the founding of modern nursing & creating the first educational system for nurses.
Florence Nightingale Declared nursing to be a respected occupation requiring _advanced education__. Established six important principles of nursing education.-look in book
Governmental agencies (Public):
Focus on the health of all U.S. citizens; supported by taxes, administered by elected/appointed officials, tailored to needs o the public
Nursing Schools Today and Tomorrow (1934) by National League of Nursing Education (NLNE)
Focused on describing schools, their curriculums and recommendations for professional education
The Study of Nursing and Nursing Education in the United States ("Goldmark Report") (1923)
Focused on the clinical learning experiences of students, hospital control of the schools, desirability of university schools of nursing, funding, and lack of ___prepared teachers ____.
________ involves _intentionality__: (Ex. Participating as a novice nurse in a "Preceptorship" helps a novice nurse overcome reality shock of practice)
Formal socialization Classroom lectures, assignments, Laboratory experiences, new vocabulary, learning a physical examination
Florence Nightingale:
Founder of modern nursing
1947: ______ as started in NY, became norm
Fully mandated licensure
Studies that build on previous work increase nursing knowledge and are more likely to receive what?
Funding
____ affect who traditionally enter nursing
Gender roles: "respectable" women who care for others
Culture desire includes
Genuine passion & commitment to be flexible Respect differences but build on similarities learn from others culture
Which approach to moral reasoning stated that women's and girls' relational orientation to the world shaped their moral reasoning to be different from that of men and boys?
Giligan's stage of moral reasoning
Effective use of electronic communication devices is important.
Give full attention to the client. Leave the client area to take calls Adopt a courteous tone in emails Avoid use of jargon Keep messages short Speak clearly when leaving return phone numbers on voicemails Read, listen, and evaluate entire messages before responding
Experimental Designs
Goal is determining a cause-and-effect__ relationship (ex: thermoregulation in preterm infants) Researcher manipulates, influences, or changes the participants in some way Must be _quantitative___ Often is impossible to conduct with human subjects, because manipulation would endanger them in some way (modified)
Subacute care services
Goal-oriented, comprehensive inpatient care for clients who have acute illnesses, injuries, or exacerbations of a disease process Inpatient care that lies between hospital care and long-term care Provides lower-cost health care and easier transition moving through healthcare system Like a hospital but smaller
Requirements for early nursing school applicants were based on Victorian stereotypes-
Good breeding & ladylike behavior Submissive to authority Sensitivity Intelligence
Confidentiality: ____ first federal privacy standard to protect patient's medical records (1996)
HIPAA (protects medical records and individual identifiable health information communicated on paper, electronically, or verbally
State Boards of Nursing
Have power to clarify provisions of nurse practice act cannot enlarge law
Four basic beliefs set forth by the ANA (2008) concerning nursing's future include position statements about:
Health care is a basic human right and universal access should be provided Development and implementation of health policies More balanced use of health care services Adoption of a single-payer health care system
Only using the scientific method with quantitative information has limitations when applied to many studied phenomena in nursing practice.
Health care settings are not comparable with a laboratory setting. The "naturalistic inquiry" of qualitative research often fits better. Clients' subjective perceptions of their experience fit with the methods of qualitative research. Fails to consider meaning of clients own experiences
Financing Health Care
Health care system is characterized as being costly & large number of unisured. How do we provide high-quality care services to all citizens while keeping costs down? These issues affect nursing based on the type of insurances nurses receive and the services they are able to afford.
World Health Organization (WHO; 1947):
Health is "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."
Parsons (1959):
Health is an individuals optimal ability to perform his/her roles an tasks effectively.
There are many models of health beliefs. Nurses should recognize the following:
Health is constantly _changing_ Health affects the entire person Individuals' health beliefs are powerful & influence how they respond to efforts to change their health behaviors. Individuals needing/desiring change may lack _knowledge__, motivation, sense of self-efficacy, and support to implement change. Increase knowledge does not always help change behavior. Various models of health beliefs can be used to assess individual, family, and group readiness to change. Change is often incremental & usually slow . Burden of action is mutually shared by clients, health care providers, and population-focused entities such as public health programs.
Orlando: The Dynamic Nurse-Patient Relationship: Function, Process and Principles (1990)
Her work proposed: How nurses process their observations of _client behavior__ How __nurses react to patients_ based on inferences from client's behavior GOAL: Determine & meet patients' immediate needs & to improve their situation by relieving distress/discomfort.
Which will provide the most opportunity for employment because most future health care services will take place in this setting?
Home Health Care
Nurses work within systems every day
Hospital Department of nursing A particular unit With a colleague group
Currently, which is the primary worksite for RNs?
Hospitals
Holistic care-
How is the family influencing/influenced by client care?
Steps in the research process include
Identification of a researchable problem Review of the literature Formulation of the research question/hypothesis Design of the study Implementation of the study Drawing conclusions based on findings Discussion and/or clinical implications Dissemination of findings
Planning (phase 3)
Identify ____client goals__. Determine ways to meet those goals. Goals are used to guide selection of interventions. Goals are also used to __evaluate patient progress___. Goals should be agreed on by both nurse and patient.
Spanish American War (1898)
Increased need for nurses Anita M. McGee (MD) appointed head of Hospital Corps to recruit nurses (younger could be trained)
Three types of nursing interventions
Independent : do not require supervision or direction by others Ex: Teaching a client how to breastfeed new baby Dependent : require instructions, written orders, or supervision of another health professional with prescriptive authority Ex: Administering medications Interdependent (collab) : require nurse to collaborate or consult with another health professional before carrying out the action Ex: Pushing IV medications for elevated blood pressure that were ordered per protocol
There are two different kinds of logic
Inductive reasoning : The process begins with a particular experience and proceeds to generalizations. Repeated observations of an experiment or event enable the observer to draw general conclusions . This type of inferential reasoning may lead the researcher to infer that this is an effective intervention, based on the responses from a small sample. Deductive reasoning__ Process which conclusions are drawn by logical inference from given premises; proceeds from general case to the specific The premises used must be correct or the conclusions will not be. Example: "All pregnant women will benefit from centering prenatal care." Both types of reasoning are required in research.
Hildegard Peplau's theory of Interpersonal Relations in Nursing
Interpersonal Relations in Nursing (1952, 1988) States that all nursing is based on the __interpersonal process and the nurse-client relationship
Roy:
Introduction to Nursing: An Adaptation Model (1976) Focus on individual as a biopsychosocial adaptive system Nursing as a humanistic discipline that promotes the person's adaptive or coping abilities, including the need for alterations in the person's environment
Orientation phase
Introductory phase: "_getting to know you_" Begins the development of trust building in the relationship Four tasks of the orientation phase 1- trust enables continued participation in the relationship. 2- Client and nurse see each other as individuals. 3- Clients perception of major problems & needs identified 4- Approximate length of the relationship will be estimated.
Secondary care services
Involves the management of a condition/illness by a specialist Include treatment of managing a clients suspected/new diagnosis, providing counseling or other therapies that primary services can not. Ex: Pulmonologist (lungs), Cardiologist (heart), Maternal Medicine (OB)
Which of the following statements about shared governance is true? (Select all that apply.)
It is the philosophy that employees have the right and the responsibility to govern their own work and time. *** It promotes improved patient outcomes. *** It makes the clinical nursing staff responsible for adhering to standards and benchmarks of quality care. ***
Nurse activists (karen daley)
Join politically active nursing organizations and __participate__ Contact public officials Contribute to a political campaign with money or work Providing or giving testimony to legislators & regulatory bodies Form or join coalitions that support an issue of concern
The inability of nursing programs to produce enough nurses to meet society's need is a result of which of the following? (Select all that apply.)
Lack of capacity in nursing schools Low salaries for nursing professors Lack of student interest in the nursing profession
Registered dietitians
Manage patients' nutritional intake using knowledge of the therapeutic value of foods and provide dietary education.
Nurse's role on the health care team: manager
Mange care of a group of clients, prioritize client care activities during 8-12 hour shift, and determine staff & client assignments. Nurses serve as managers for patient units, outpatient clinics, or home health agencies. Nurse managers have clinical and administrative expertise.
Dissemination of findings may involve which of the following activities? (select all that apply)
Manuscript reviewed by peers Oral presentation of findings at annual conference of the Society of Pediatric Nurses Poster presentation at regional conference of Sigma Theta Tau International Publication of findings in Western Journal of Nursing Research
Medical staff governance:
Medical staffs are often organized by services, with chief of staff as the head.
1965: _____ & _____ ensured access to health care for the elderly, poor, and disabled
Medicare and Medicaid
A National Health Initiative: Healthy People 2020
National initiative to improve the health of our nation Grew out of the 1979 surgeon general's report on health promotion and disease prevention Twenty-six leading health indicators (LHIs) organized into 12 topic areas that focus on _quality of life_, healthy behaviors & healthy __human development__across the lifespan Powerful idea: provide health objectives in a format that enables _diverse groups to combine efforts and work as a team_
Occupational hazards in nursing settings include:
Needle stick injuries and possible infection from blood borne pathogens Exposure to chemicals such as disinfectants and chemotherapeutic agents Violence in the workplace Latex allergy Injuries from back strain and accidents Shift work Stress from work overload and inadequate staffing Intense feelings generated by caring for acutely ill and dying patients.
Middle Range Theories
Neither overly broad or narrow in scope Usually incorporate a limited number of concepts Focus on a specific aspect of nursing & based on research___ Often embedded within a larger theory Typically merge practice and _research__ Well known middle-range theories include: Swanson's (1991) Caring Theory Mishel's (1988) Uncertainty in Illness Theory Dobratz's (2011) Psychological Adaptation in Death and Dying
Nurses join organizations to
Network with colleagues Pursue __continuing education_ & certification opportunities (CEUs) Stay informed of professional issues Develop leadership skills Influence Work collectively for job security Fewer then 20 % of U.S. RNs belong to one of the many specialty nursing organizations. Nurses cite many issues for not joining: job too demanding... don't have time... you have to pay
Florence Nightingale
Notes on Nursing: What It Is and What It Is Not (1859) Health, illness, and the nurse's role in caring for patients Relationship of clients with their environment Focused the profession on Person Health Environment Nursing . She believed that health was related to clients' environments. Cleanliness in hospitals, little noise, good environment for healing She recognized nursing's role in protecting patients. protecting from patients family, amount of visitors,
Three levels in which nurse may get involved:
Nurse Citizens Nurse Activists Nurse Politicians
Your SBN is responsible for enforcing the _____ in your state
Nurse Practice Act -publish rules and regulations that expand law -revise to keep up with new health care developments
The ________ is the statute that defines nursing practice
Nurse Practice Act (it also defines authority of the state board of nursing)
Working phase
Nurse and client tackle tasks outlined in orientation phase. Patients may exhibit alternating periods of intense effort and periods of __resistance to change__. Regression is an ego defense mechanism that occurs as a reaction to stress. Regression often precedes _positive changes in behavior__. Your response as a RN... -when patient is regressing, encourage them to make progress again. Support them
Termination Phase
Nurse and patient take on those activities that enable them to end the relationship in a therapeutic manner. _positive and negative_ feelings often accompany the termination process. Positive feelings are often about gains made. Negative feelings are often sadness, anger, and fear. Must be discussed toward acceptance
Nurses can be instrumental in improving these systems, especially community systems.
Nurses also can influence larger systems by becoming _politically active_ by running for elected offices at local, state, and national levels. Nurses have the potential to favorably impact the environment/suprasystem through individual, community, and national efforts. Environmentally friendly decisions; "green teams"
Roy's model in practice
Nurses assess clients adaptation to environmental stimuli; both internal and external environments. Nurses next develop nursing diagnoses as a result. Guide goal setting & interventions Nurses modify the environment to facilitate patient adaptation. Examples: Construction worker undergoes an amputation. Then goes back to school to become a lawyer. Patient with anemia experiencing fatigue so the nurse makes changes to the patients care schedule so rest/sleep is predominate.
Information (technology)
Nurses assume responsibility for data entry and retrieval using computer based applications on the unit, at the bedside, or hand-held, which communicate, store, manage, retrieve, and process information
Goal of self-awareness:
Nurses can distinguish their __own emotional needs___ from their patients' needs and get their own emotional needs met outside the nurse-patient relationship.
Institutions with funding through Centers for Medicare & Medicaid Services are under particular scrutiny
Nurses experience moral distress when they are unable to implement a correct action due to institutional policy constraints. Institutional ethical committees exist to assist with ethical dilemmas in their settings. Multidisciplinary groups charged with providing consultation and emotional support about ethical choices
King's model in practice
Nurses focus on goal attainment for and by the patient. The steps of the nursing process describe the action the nurse is taking. At each step the nurse gathers information to provide care. King's model is not linear; steps occur simultaneously as the nurse and patient work together. Care is guided by concepts at each of the system levels. Example: The personal system leads the nurse to explore a patient's personal roles and stresses OR social system- is something impacting their decision? Key component to this process are _interactions with clients__ GOAL: _Attaining/Regaining Health_
Which document provides a framework for nurses to understand the nursing profession's relationship to the wider society?
Nursing's Social Policy Statement: The Essence of the Profession (ANA, 2010)
Internal Conflicts (barriers to professionalism in nursing)
Nursing's power and influence is fragmented by subgroups and disagreement, including differences in educational levels and proliferation of organizations that compete for nurses' membership
Which organization is responsible for ensuring nurses work environment is safe?
OSHA
Writing patient goals and outcomes requires using:
Outcome criteria which are specific and make the ___make the goal measurable____ Ex: "The client will be able to walk 3 blocks a day with a can within 1 month after hip replacement surgery" Time frames short-term- attainable within __hours or days__ long-term- attainable in __months or years
State agencies:
Oversee programs that affect the health of citizens with an individual state; state board of nursing; license & support local agencies that provide direct care.
Three components writing diagnoses:
PES Problem, Etiology, Signs & Symptoms (defining characteristics)
Policy
Policy involves principles that _govern actions_ directed toward given ends. Policy statements set forth a plan , direction, or goal for action. Policies may result in laws, regulations, or guidelines that govern behavior in public or private arenas, such as health policy. Policy decisions reflect the values and beliefs of those making the decisions. Example: American Nurses Association (ANA) focuses on policy issues of health promotion, illness prevention, and nursing practice.
Avoiding _stereotypes
Prejudices and __negative attitudes__ towards groups developed through social & cultural interaction Goal: accept all patients as individuals of dignity and worth who deserve the best nursing care possible
Doctoral Education
Prepare for teaching as faculty in universities, administrators in nursing schools or large medical centers, researchers, theorists, and advanced practitioners
Current Methods of Payment for Health Care
Private insurance (voluntary insurance): Insurance premiums are payed by or shared between individuals and employers. Medicare: This is a nationwide federal health insurance program that was established in 1965 for people ages 65+ , regardless of income. Also covers certain groups of disabled people Contains Parts A, B, C, D Medicaid: This is a group of jointly funded federal-state programs for low-income, elderly, blind, and disabled individuals, established in 1965. People must meet eligibility requirements that are determined by their state. Personal payment: out-of-pocket payment, least frequently used method for financing health care Workers' compensation: covers workers who are injured on the job Program varies from state to state Covers treatment for injuries during time worker is absent from work for injury-related causes
Tertiary care services
Provided to acutely ill or injured clients, those requiring long-term care or rehabilitation services, and for the terminally ill Can be a hospital , trauma center, burn center, or pediatric hospital, long term-care facilities, rehabilitation centers, or through hospice services
ANCC Magnet Recognition Program
Purpose is to "recognize health care organizations that provide the very best in __nursing care and uphold the tradition of professional nursing practice_" (ANCC, 2009) Demonstrates the importance of nursing and nurses Signals the importance of quality care and a positive practice environment Recognizes high caliber of the nursing staff validating their hard work & elevates self-esteem.
Which of the following types or research are most commonly used in nursing?
Qualitative
A critical thinker:
Raises questions and problems and formulates them clearly and precisely __Gathers and assesses ___ relevant information __Arrives at conclusions and solutions __ that are well-reasoned and tests them against relevant standards Is _open-minded__ and recognizes alternative views __Communicates effectively (with others)_ about solutions to complex problems
Bachelor's-degree-prepared nurses can: (research)
Read, interpret, and evaluate research for applicability to nursing practice_ Identify _nursing problems_ that need to be investigated Participate in implementation of studies by _assisting researchers in data collection Disseminate research-based knowledge by _sharing useful findings_ with colleagues
Socialization is a lifelong activity. Necessary adaptations include:
Realizing that ideals taught in school are not always possible to achieve in everyday practice Establish _positive relationships__ Recognizing that the speed of functioning increases in a work setting, compared to a nursing school setting TIME MANAGEMENT The need to collaborate with many types of nursing personnel Fatigue, mental and emotional stress Lack of role clarity, Integration into a peer group , Uncertainty about policies and procedures leads to Sensory overload Developing and contributing to a culture of _civility_ (show respect to others)
Nurse politicians
Run for __elected office__ Seek appointment to a regulatory agency Be appointed to a governing board in the public or private sector Use their nursing expertise as a front-line policymaker to enhance the quality of health care and the __profession___
1933: Civil Works Administration (CWA) nurses provided ____ and ____ health services for families who could no longer afford nursing services
Rural and School
Severe Anxiety_
Scattered thoughts, difficulty with verbal communication, considerable discomfort, purposeless movements
First school exclusively for men:
School for male nurses at the New York City training school (1986)
SBNs set and enforce minimum criteria for nursing education programs
Schools of nursing must have state approval to operate
(Chicago World's Fair) Paper by Florence Nightingale
Scientific training for nurses in better care
Resourcefulness can be taught as a form of coping. These skills include:
Self-regulation Problem solving Conflict resolution Emotion management
Five major elements must be present for communication to occur.
Sender: person sending the message Message: what is actually said plus accompanying nonverbal communication Receiver : person acquiring the message Feedback: response to the message Context_: setting in which the interaction occurs
Local agencies:
Serve one community, one county, or a few close counties to both paying and nonpaying citizens. Ex: Community health nurses
Cohen developed a model based on developmental theory & studies of beginning nursing students' attitudes. Four stages experienced in sequence
Stage 1: ___unilateral dependence___ Inexperienced/lack of _knowledge_ "I know I can care for this patient with your guidance and directions!" Stage 2: ___negativity/independence____ ___critical thinking___/knowledge expands "Why do I have to go to lab for validation of vital signs? I would learn better on a patient!" Stage 3: Dependence/mutuality Increased realistic appraisal process & _learn to test ___ concepts, facts, ideas and model objectively. Appreciate nursing process in organizing care & sophisticated critical thinking "I can see how practicing in the lab improves my skills & will help me do a better patient assessment!" Stage 4: __interdependence____ Need for _independence_ and mutuality come together "Since I work as a nurse technician in a Psychiatric Unit and desire to be a professional in this field, can I also do part of my clinical rotation with a Psychiatric Home Health Nurse to expand my exposure?"
Internal, external, and interpersonal stressors
Stress is defined as the nonspecific of the body to any demand made on it (Selye, 1956). Internal: self and self-perceptions External: environment, such as noise, cold, malfunctioning equipment, bad weather Interpersonal: demands made by others; conflicts with others
Need to transform nursing education to meet the need for quality & safety in an increasingly complex health care environment (QSEN)
Students are not being educated to care for the _increasingly diverse patients_____. Students are not being prepared to _work in teams____ Students are not consistently educated in how to access & _use evidence based practice___. Students unprepared to identify and __eliminate errors and problems_____. Students not provided basic informatics (computerized) training
External Degree
Students attend __no classes__ -Learning is independent via online study "Virtual university" -Students are responsible for setting up their own clinical experiences. -They can include _ADN, BSN, and MSN____ -Exercise caution and ensure accredited school.
Nurse's role on the health care team: educator:
Teach about illnesses, medications, treatments, and rehabilitation needs to families, Community Groups, Student Nurses, Health care team members & more! Help clients understand: How to deal with life changes resulting from chronic illness How to adapt care to the home or community setting Educate other team members on finding cost-effective & desirable, high-quality interventions. Educate proper use of internet through ensuring clients use reliable websites and evaluate information they find.
Primary purpose for licensure of nurses:
The protect the health, safety, and welfare of the public
National Council of State Boards of Nursing (NCSBN) and the Forum of State Nursing Workforce Centers (FSNWC) developed
There own comprehensive national survey in 2013 -Focuses on number of nurses in the workforce, gender, age, race, ethnicity, and education levels
Advance directives are legal documents that indicate the wishes of individuals in regard to end-of-life issues
These documents help avoid family conflicts at a time of great distress and vulnerability
Individual philosophies are formed by each nurse as she/he accumulates practice experience in the profession
They are principles that underlie your thinking and conduct . They are the basis of your day-to-day professional behavior.
Define Critical Thinking
Thinking through problems thoroughly using reasoning skills from extensive knowledge about a topic. Inquisitive, open-minded, honest, open-minded, persistent,
What is ethnocentrism?
Thinking your own culture is superior to others
Planning, which is the third phase of the nursing process, begins with the identification of patient goals and a determination of the ways to reach those goals.
True
Sound nursing theory provides both a systematic way of thinking and the tools to challenge conventional views.
True
Values Clarification
Understanding your values is an important step in self-awareness for nurses. It is critical for maintaining a nonjudgmental approach to patients
Health Care Reform and Universal Access
United States and South Africa are the only two industrialized nations that do not provide universal access to health care to all citizens. President Obama signed Affordable Care Act (ACA). It includes comprehensive reforms to improve access and protect consumers from abusive insurance company practices. It is unlikely that a systematic and comprehensive reform of the entire health care system is possible. However, can expect state-by-state efforts to address issues. Most experts agree that reform efforts must be designed to reduce OR not increase cost of health care in order to be supported by Congress.
Economics of nursing
Until recently, few efforts were made to determine the actual cost of nursing care. Assumption: the cost of nurses was a large contributor to overall hospital expenses. Patient classification systems were developed to help determine need for nursing care and to evaluate costs. Research shows a link between nursing & quality of care means demand for nurses will continue to increase.
Resourcefulness
Use of _cognitive skills__ that one creatively uses to adapt to the world around oneself.
Telehealth nursing
Use of technology in nursing (electronic charting, etc)
Barriers to professionalism in nursing
Varying levels of preparatory education: nurses can be licensed to practice without a bachelor's level of education, as required by other professions Gender issues: there is a diminished value of female dominated professions such as nursing, social work, and teaching Historical influence: religion and military teach values of unquestioning obedience (runs counter to professional values of autonomy, self-determination, and altruism)
Levels of communication
Verbal_ consists of all speech Non-verbal__ includes all non-speech: grooming, clothing, gestures, posture, facial expression, eye contact, tone/volume of voice & actions
Which nursing theorist developed the definition of nursing that focused on the interpersonal relationship between nurse and patient ?
Virginia Henderson
Nurse citizens
Vote in every election Stay informed and _speak out_ about health care issues Participate in public forums Join politically active nursing associations Participate in __community organizations_ as health experts Know your local, state, and federal elected officials
Post-World War II Definitions
WWII advanced technologies available for nursing, influencing nursing and required changed definitions influence emotions had on health, illness, and nursing care
The central question in malpractice charge is ______
Was the prevailing standard of care met? Standard of care reflects basic minimum level of prudent care
Watson's theory in practice
Watson's caritas processes guide nurses by specifying the meaning of the relationship of nurse and patient as human beings. Clients' _spiritual strength_ is recognized, supported, and encouraged. Caring itself is now considered to be a central concept of the discipline of nursing. Key aspects of nursing's metaparadigm in Watson's work: Environment Person Health Nursing
Cyberchondria
When someone has an online concern about self
Flexibility
When the speaker bases messages on the immediate situation rather than preconceived expectations
Efficiency
When the speaker uses simple, clear words that are timed at a pace suitable to participants
X and Y
X = problem (example patient sleeplessness) Y = variable (example unit noise levels)
Nursing process should be used as a ______
_creative approach to thinking____ and __decision making in nursing____
The nursing process is
a method of critical thinking focused on solving client problems in professional practice. A conceptual framework that enables the student or nurse to think systematically & process pertinent information about the client (Huckabay, 2009) It is taught in schools of nursing across the United States. Many states refer to it in their nurse practice acts.
Cultural competence:
a nurse's knowledge about cultural influences that she/he can use to __plan appropriate approaches to a client's needs___ Without cultural competence, nursing care can be compromised leading to multiple problems.
Nursing diagnoses must be:
accurate prioritized Life-threatening Potential to cause harm or injury Related to overall health
effective communication skills
active listening_involves focusing solely on a person and acknowledging their feelings in a nonjudgmental manner. It includes open posture: ex: Venting describes verbal "letting off steam" about frustrations. HA:
1916: African American students
admitted to ANA through constituent states in North
Changes in health of one member
affect all members___. The entire family system is affected. Individual and family coping abilities are critical factors in how well a family tolerates stress. Stress is increased whether the ill family member is hospitalized or cared for in the home.
Environment includes
all circumstances, influences, and conditions that _surround and affect__individuals, families, and groups The environment can promote or interfere with homeostasis and well-being. Beginning with Florence Nightingale, nurses have always been aware of the influence of environment on people. These include: Public health: safety of food, water, air, cosmetics, medications, workplaces Family, cultural, social, and community systems
Clinical Ladder Programs
allow nurses to progress upward through direct-care roles (Clinical nurse specialists (CNSs) are at the top of most clinical ladders)
Rapid expansion of facilities resulted in ______
an acute shortage of nurses Result: "team nursing" was introduced -group of patients cared for by group of caregivers -removed RN from bedside -resulted in efficient but fragmented care
Bioethics:
application of ethical theories and principles to moral issues or problems in health care
Professional boundaries are
are "the spaces between the nurse's professional power and the patient's vulnerability. The power of the nurse comes from the professional position and the access to private knowledge about the client" (National Council of State Boards of Nursing [NCSBN], 2014)
Ethics:
are codified actions that specify what actions an individual should take
Stakeholders:
are individuals or groups who are affected by the decisions. They also have a vested interest in influencing the politicians, or others in power, who make the policy decisions. Stakeholders can include health care professionals, affected patients and families, administrators of nursing organizations, hospitals, etc. -great impact a stakeholder has, greater chance their policy will take place The greater an impact stakeholders make in influencing politicians, the greater will be the likelihood their preferred policies will be implemented.
Morals:
are standards of behavior that guide the actions of an individual or social group and are established rules of conduct to be used in situations where a decision about right and wrong must be made
Battery:
assault carried out: impermissible, unprivileged touching actual harm may or may not occur
Primary source-
assessing original writing will provide clarification about theorists thoughts & how concepts relate Explanatory/interpretive articles
Health promotion & maintenance
assist clients to remain healthy, prevent diseases and injuries, detect disease early , and promote healthier lifestyles. Ex: wash hands, go in for prevention visits, vaccinations, healthy diet, exercise,
Social workers
assist patients and their families to cope with the impact of illness or injury and serve as liaisons between patients and community resources and services
Profession is an occupational group with a set of _______
attitudes, behavior, or both
Values:
attitudes, ideals, or beliefs that an individual or a group hold and uses to guide behavior
Advance Directives are designed to ensure individual rights of _____, _______ and death with ______
autonomy, refusal of medical intervention, and dignity
All patients or their guardians must grant informed consent ____ except for life-threatening emergencies
before treatment
Principalism: uses the key ethical principles of __________
beneficence, nonmaleficence, autonomy, and justice to resolve ethical dilemmas
The health status of people is influenced
by the larger systems in which people live; availability of jobs, housing, schools, and health care.
Nurses must find balance between
caring for others and self-care . Most nurses are not accustomed to taking care of themselves. "Creating a balanced life rather than merely maintaining a balancing act" Diann Uustal (2009)
Men's motivation to enter nursing are similar to women's-
caring, desire for stable career, economic & job security
Implementation is the actual
carrying out of orders_____ This must be done in an orderly and competent manner. Continually assessing the patient as implementation progresses. Documentation of nursing actions is an essential and integral part of the implementation phase.
1920: Mary Adelaide Nutting:
chaired the National Committee on Nursing to: supply trained nurses for the US army hospitals Found the Army School of Nursing
Clients have become increasingly likely to
challenge providers_ and to seek out their own information
Social media:
changed landscape of communication and is increasing ethical problems in nursing
External causes: (nursing shortage_
changes in demand for nurses, increasing age of population and of nurses, alternative career options for women
Acute illness
characterized by severe symptoms that are relatively __short-lived__ Symptoms tend to appear suddenly, progress steadily, and __subside quickly__. Client may or may not require medical attention. Some acute injuries or illness can lead to chronic illness.
Valuing is the process by which values are determined. Three steps include
choosing, prizing, and acting.
Relationships among nursing research, practice, and theory are
circular
Expert nursing requires developing excellent
clinical judgment.
"Closed" vs "Open" Shop:
closed is unionized Open is not required to be unionized
ANA's 2004 Nursing: Scope of Standard of Practice includes:
collegiality as one of the nine standards of professional performance
Mixed-Methods
combination of quantitative & qualitative
Office based nursing:
communicate with nurses, aids, family members, hospital admissions, pharmacy, etc. (develop relationship with patients but must have experience in expertise area)
Nurse Licensure Compact (NLC) allows RNs to have one license yet practice in other ____
compact member states
When others' needs take too great a priority, nurses experience
compassion fatigue Compassion fatigue is defined as _negative feelings__ in which one experiences loss of physical energy, burnout, accident proneness, emotional breakdowns, apathy, indifference, poor judgment, and disinterest in introspection (Coetzee and Klopper, 2010).
Nursing philosophies and theories often derive from or build on
concepts identified by other philosophers.
External Conflicts (barriers to professionalism in nursing)
conflicts with medicine are increasing as nurses are able to provide services that were formerly part of medical practice by physicians The legal scope of nursing practice must be protected through lobbying and legislation nurses must strive for cooperation with other medical disciplines
Congruent vs incongruent communication
congruent: Verbal and nonverbal are consistent and reinforce each other. Incongruent : Speech and non-speech do not match.
Traditional, scientific, quantitative research has
considerable value for nurse researchers in studying a wide range of nursing problems (Polit & Beck, 2004).
Throughput
consists of the processes a system uses to convert raw materials (input) into something beneficial.
Nightingale's definition of nursing:
contains many concepts that remain contemporary includes importance of assessment skills, unique body of knowledge, and professional practice impact of the patients' immediate environment, nutrition, hygiene, comfort
Nursing diagnosis as part of the nursing process:
defined as "a clinical judgment about individual, family or community responses to actual or potential health problems or life processes which __provide the basis for selection of nursing interventions__ to achieve outcomes for which the nurse has accountability" (North American Nursing Diagnosis Association International [NANDA-1], 2012)
"Authority"
defined as legitimacy to exert power, or to enforce laws, demand obedience, make commands or determinations, or to judge the acts of others
Peplau
describes a four-pronged process for the nurse to assist the patient in achieving personal growth
Occupational therapists
develop plans to assist patients in resuming the activities of daily living after illness or injury, such as cooking, dressing, and driving.
Bandura (1997)
developed "Perceived self-efficiency "- whether people considered altering their detrimental health habits depended on their belief in themselves as having the ability to modify their own behavior.
Stress plays a major role in the
development of illness__. Links to prolonged stress and decreased body function. Cortisol is released which affects ones metabolism_ and _immune response___. Increased risk for weight gain, poor healing, high blood pressure, skin disorders, and more!
Conflicts evolve from:
differing value systems cultures, educational levels or other factors (occur between a nurse's value system and the institution's practices, occur when nurses or other healthcare providers routinely fail to meet standards of care, occur when healthcare workers break basic norms of conduct towards others, especially patients)
Conflicts are:
dilemmas that easily develop, particularly in stressful circumstances
The best means for developing expert clinical judgment is to gain extensive
direct patient contact___. This requires recalling facts, ____recognizing patterns in client behavior____, forming a meaningful whole, knowing your limits, and acting appropriately. Ex: Elevation of temperature in postoperative client RNs responsible own clinical judgment and accountable for their own actions
Nurses personal health practices
directly affect their clients
Comprehensive appraisal through National Sample Survey of Registered Nurses (NSSRN)
discontinued
Nonmaleficence:
duty to do no harm -it is the foundation of medicine: therefore critical for nurses some good things may cause harm
APNs have increased _______ and ______ of primary health care delivery in the United States while reducing costs
efficiency & availability
Information med. technologies include:
electronic medical records, bedside computer systems, nurses' personal information systems, and online reference tools for nurses
There was increased _____ and ______ for nurses in hospitals
employment and specialization (intensive care, cardiology, psychiatry, additional responsibilities due to shortage of primary care physicians
Certification gives nurses greater earning potential, wider
employment opportunities___, broader scope of practice, __validation of skills____, knowledge, and abilities; public recognition; a sense of personal satisfaction and prestige.
Administrative support personel
ensure operations of the facility run smoothly. They are needed for clerical jobs such as admitting patients, answering phones, directing visitors, scheduling patient tests, filing insurance claims, and more.
Justice:
equals should be treated the same and unequals should be treated differently -in healthcare, justice relates to the allocation of resources
Today's diploma programs usually have:
established agreements with colleges and universities to allow college credit for courses. Current practicing nurses may have a diploma degree, "__grandfathered___"
NCSBN
established in 1978 to develop the examination each state participates to licensing process through NCSBN Each state is responsible for licensing through state board of nursing
1925: Mary Breckinridge___
established the Frontier Nursing Service (FNS) -Breckinridge provided the first organized midwifery program in the United States -Nurses worked in rural Appalachian Mountains to serve needs of poverty-stricken residents -They traveled by horseback to deliver babies, educate families, and care for the sick
Respiratory therapists
evaluate patients' respiratory status & assist patients in breathing through use of equipment such as ventilators, oxygen therapy devices, and perform some diagnostic procedures.
Three functions mirror federal and state governments: (SBN)
executive: administers nurse practice act legislative: adopts necessary rules to implement act judicial: authority to discipline a licensee or licensure or deny licensure
Nursing research is _______ and requires a variety of types of support.
expensive Support includes: Encouragement_ Consultation Computer and library resources Funding money Release time from researcher's regular responsibilities More funding is available than in earlier years of nursing research. However, financial support still can be difficult to obtain, particularly for _new researchers__.
______ staffing provides relaxed, formerly rigid, work schedules
flexible
Certification is effective for
for 3-5 years where individual must apply for recertification either based on retesting or by demonstrating continuing education credits and evidence of ongoing clinical practice
Doctorate of nursing practice (DNP):
for _practice in advanced clinical roles___ May provide a solution to shortage of primary care physicians
Doctorate of philosophy (PhD):
for a __research___ or theory focus
The Civil War prompted a move toward ______
formal education of nurses
Nursing's Social Policy Statement: The Essence of the Profession (ANA, 2010)
framework for understanding nursing's relationship with society- contemporary definition of nursing
Values:
freely chosen principles, ideals, or standards held by an individual or group that give meaning and _direction__. A representation of what is right, worthwhile, or desirable Most observable human behaviors are manifestations or consequences of human values. "Nursing is a behavioral manifestation of the nurse's value system. It is merely a career, a job, an assignment; it is a ministry" says Uustal (985, p. 100)."
Technological Developments: (four types)
genetics, biomedical, information, knowledge
Genetics (technology)
genonomics, epigenetics, and pharmacogenetics will shape foreseeable future of health care and nursing practice
Delegation:
giving someone authority to act for another -professional nurses retain accountability for acts delegated to another person
All students should meet minimum
graduation requirements
Malpractice:
greatest legal concern for nursing practice
Build a Body of Knowledge =
has to be: Based on published _research findings_ _Fit logically with what is already known_
Diagnosis and treatment
have a heavy emphasis in health care. Modern use of medicine to diagnose and treat illnesses; _less invasive__
The epidemic (HIV) globally changed the landscape of ____ quickly
health care
Nursing is the largest
health care profession in the United States.
Failure to care for the environment has ________
health implications
Differentiate nursing from other ______
health occupations (address wide variety of health issues: keep nurses in key positions of influence)
Federal agencies:
health of U.S. citizens; promote & conduct health & illness research, provide funding to train health care workers, and assist communities in planning health care services. Ex: Centers for Medicare & Medicaid (CNM), Centers for Disease Control and Prevention (CDC)
Rehabilitation and long-term care
help restore the patient to the _fullest possible level of function_ and independence following injury or illness. -Disease management services: people who already have a chronic condition -Lower health care cost (educate patients) -Long-term care:
(Civil War) Mary Ann Bickerdyke:
herbalist -> field hospitals
Certification goes beyond licensure to validate a high
high level of knowledge and proficiency in a practice area.
A ____ proportion of male registered nurses work in hospitals than female RNs
higher
Programs should be established within the system of
higher education__.
There has been a tremendous increase in _____ services
home health- with predictions that most future health care will take place in patient's homes (home health patients have significant illnesses & need very strong assessment and communication skills)
This balance between the subsystems, the system, and the suprasystem helps create and maintain
homeostasis (internal stability )
When a person's needs are not met
homeostasis is threatened. Adaptation may or may not be successful.
Nursing shortages are usually confined to ______
hospitals and nursing homes
Home Health care positions are expected to ______
increase faster than hospital positions -technological advances -increase in primary care -aging of nation's population -increased percentage of medical procedures performed in outpatient settings
Reforms in health care are
increasing demands_ for master's-prepared and doctorally prepared nurses. Increased need for NPs causing masters programs to expand practitioner tracks. -more efficient, cost effective
Care plans are ______
individualized. Based on standardized care plans OR Based on an individually created care plan Some settings use "critical pathways" as multidisciplinary frameworks for plans of care. Critical paths are written in collaboration with physicians and other health care providers.
Autonomy:
individuals have the right to determine their own action and the freedom to make their own decisions -respect is the cornerstone
Autonomous decisions are based on:
individuals' values adequate information freedom from pressure reason and deliberation
1917: _____ & U.S. enter WWI
influenza pandemic (Nurses demonstrated ability to respond effectively to both needs)
There is rapid development of ______ technologies in health care
information
Clinical Judgement consists of
informed opinions__ and decisions based on empirical __knowledge and experience/ expertise_____.
Abraham Maslow explained that human behavior is motivated by
intrinsic
Woodhull Study on Nursing and the Media (1977) concluded that nurses are ____ to the media and public
invisible
"Grand theory"
is a very broad conceptualization of nursing
Patient-Centered Care_(PCC)
is an approach to assist in solving some problems in healthcare
Evaluation
is measuring the success or failure of the output and, consequently, the system's effectiveness.
Chronic illness
is one of the fastest growing health problems in the United States. In 2015, almost half of the U.S. population had one or more chronic illnesses. Chronic illnesses are caused by __permanent changes__ that leave residual disability.
Output
is the end result or product of the system
Traditional therapuetic relationship
is the grounding for the therapeutic use of self.
Collective power
is the only way nursing will effectively address and resolve issues.
Feedback
is the process of communicating what is found in evaluation of the system to determine whether or not the end result of the system has been achieved.
Input
is the raw material that enters a system and is transformed by it.
collaboration
is working jointly with other professionals, all of whom are respected for their unique knowledge and abilities To improve a clients health status or to solve an organizational problem diciplinary learning involves: Learning others' specific roles and contributions Reducing stereotypes Alleviating misconceptions about the value of other professionals' roles
Nurses are _____ group of health care providers in the United States
largest
American Nurses Credentialing Center (ANCC) is largest
largest certification body in the United States. 40 different certification programs for BSN and advanced degrees.
________ with negative health behaviors of patients
learning to cope
Confidentiality is both a ____ & ____ concern
legal and ethical concern
Role changes for nurses require expansion of ____ for nursing practice
legal authority -increases in the scope of nursing practice, especially advanced practice nurses (APNs) -prescriptive authority -supervision of UAP
State licensure of a registered nurse (RN) derives from
legislation that defines scope of practice. State Nurse Practice Act
Lowest 10% (salary)
less than $45,040 (in physician's offices)
These serious injuries require:
long term rehab and nursing care, with needs including: lower extremity injuries, missing limbs, PTSD, neurologic deficits, etc.
Research deals with _______ rather than immediate
long-term solutions Provides systematic investigation of phenomena (events or circumstances) related to _improving patient care_
Early 20th century definitions:
many definitions were basic and spare Virginia henderson's definitions represented the emergence of contemporary nursing
Preventative measures included:
massive changes in the daily routines of nurses -needle/intravenous use and disposal, routine glove use, strict protocols for handling blood products
Maximizing education
means to become as educated as possible and work at the limits of your education. BSN as entry level into the field of nursing DNP for upper level education The doctorate of philosophy (PhD) will remain the degree for nurse scientists. Needed to advance the science of nursing (research)
healthcare settings can hire:
medical interpreters and translators (these skills require knowledge and expertise that should be the responsibility only of a professional medical interpreters and translators) International Nurse Migration- immigration of nurses
(HIV AIDS) There was an enormous increase in the use of ______
medical technologies: Technical Life Support: first became widely used during this time This raised important ethical questions about when and how to use life support appropriately Prominent medical/legal cases prompted consideration of patients "right to die" and treatment of "persistent vegetative states" (DNR, etc)
A conceptual _____ or _______is a more specific organization of nursing phenomena than a philosophy.
model or framework
Improved initial care in the field prevents
more deaths but also increases number of live soldiers with serious injuries
Nurses are participating ______ in politics than in the past
more effectively Nursing political action committees (PACs) Nurses' endorsement of candidates: local, state, and national Identifying health problems as policy programs Drafting legislation in collaboration with legislators Lobbying governmental officials Filing suits to implement health policy strategies for consumers Nurses strategic action teams (N-STAT) of ANA
Nurses work in a variety of roles:
most provide direct patient care
Nursing leaders understand and monitor connections between
nursing practice_ and the larger world of _politics and policymaking
SSeveral issues contribute to "reality shock" for new nurses. These include:
nursing shortages___- increased aging population Nursing staff retention ^Difficult working conditions Older, more chronically ill patients Absence of __positive__ reinforcement Lack of frequent __communication____ Kramer (1974) discusses causes Lack of support Gap between ideals and actual work setting Inability to implement desired nursing care
ANA code of ethics addresses ________
obligations of confidentiality
Basic/Pure/Bench Science
obtained for the sake of obtaining new knowledge Summarizes & explains scientific phenomena without regard for whether the information is immediately useful.
boundary violation
occur with confusion between the needs of the nurse and those of the patient.
Syngergy
occurs when all subsystems work together to create a result that is not achievable independently.
Nurses must identify a sense of _______ and be able to identify clearly what they believe is to be _____
of their own values... good or right
Nurses are encouraged to view spirituality as
one aspect of the whole person. nonjudgmental attitude towards beliefs
Principle of "double effect"
one may produce a distressful/undesirable effect if the intent is to produce an overall good result (risking harm is justifiable)
Science is based on
one or more past scientific achievements/accomplishments that are acknowledged by the scientific community for further study/practice (Kuhn, 1970).
Belief system:
organized beliefs that serve as a guide for thinking and _decision making
Three phases to the traditional nurse-client relationship
orientation : introductory phase working : address tasks termination : therapeutic end to relationship
Nursing: Scope and Standards of Practice 2nd edition (2004)
outlines expectations of the professional role of practice delineates standards of care
Eventually faced problem of being _____ in the US
outside the higher education system (Colleges & universities did not recognize the diploma as an academic credential, refusing college credit)
The percentage of RNs practicing in the United States who were educated in Indian or the Philippines is _______ compared to general population
overrepresented
Hospitals/other healthcare institutions implement their:
own policies and procedures and also must be in compliance with governmental regulations (dilemmas may arise for nurses when they disagree with these)
Communication/language problems between patients and health care providers
patients who do not speak English and hold health beliefs and practices of diverse cultures pose a challenge.
Nursing research focuses on
patients' responses amendable to nursing care__
Common ethical dilemmas in nursing include conflicts between:
patients, their families, health care professional and institutions
1903: Four States created _____
permissive licensure established "title protection" for nurses in these states
1923: All states required examinations for ______
permissive licensure, though not standardized
Responses to stress can include:
physiologic : fatigue, muscular tension/tightness, increase in heart rate and respirations, insomnia or excessive sleeping, eating impairment Social and emotional: social isolation, distancing from others, hopelessness, perception of lack of control, irritability, impatience Cognitive: interference in cognitive functioning, decreased mental capacity and problem-solving skills, difficulty making decisions
Hildegard Peplau
pioneer in nursing theory development
The ability of individual nurses to provide care is significantly affected by public
policy decisions
