Scientific Foundations of Professional Nursing Practice Exam 1

Nursing definition

"Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations"

HIPAA

(Health Insurance Portability and Accountability Act of 1996) is United States legislation that provides data privacy and security provisions for safeguarding medical information.

Patient-Centered Interview

-An interactive exchange between the nurse and patient which will become the basis for forming trust and a therapeutic relationship with patients/families. -Nurse assesses for verbal and nonverbal cues and communication.

Steps of the Nursing Process

-Assessment -Diagnosis -Outcomes Identification -Planning -Implementation -Evaluation ADOPIE

What are the three levels of critical thinking in nursing?

-Basic (novice) -Complex -Commitment

What are characteristics shared by all scientific disciplines?

-Distinct body of knowledge -Distinct schools/colleges -Baccalaureate is entry-level -Doctoral education is discipline-specific

What are some sources of Diagnostic Label Errors?

-Errors during data collection -Errors in the interpretation/analysis of data -Errors in clustering (usually occurs when the nurse clusters data too early, incorrectly, or not at all) -Errors in diagnostic statement (Use only NANDA-I terminology)

What are the three classifications of patient priority?

-High Priority -Intermediate Priority -Low Priority *Ranking of priorities is dynamic, not the same with every patient.

What does the nursing process allow the nurse to do?

-Identify patient responses to health/illness situations -Plan ways to assist patients in dealing with those situations -Implement needed nursing care -Evaluate effectiveness of care given

How does the nurse determine outcome achievement?

-Identify the EO was established -Compare the patient's status after nursing care is given to the EO. -Decide the extent of outcome achievement **Did the patient fully achieve EO?

Basic --> Complex

-Not automatic; requires experience -Complex thinkers analyze the situation and examine choices with more independence. -They also recognize that each solution has benefits/risks that should be considered.

What are the types of nursing diagnoses?

-Problem-focused -Risk-for -Health Promotion (Readiness for)

What is the purpose of nursing diagnosis?

-Provide precise definition of a patient's response to health problems. -Give nurses common language and ability to communicate what they do -Distinguish nursing role from that of other healthcare workers. -Fosters development of nursing knowledge. -Helps nurses focus on the scope of nursing practice.

Complex Critical Thinking

-Thinking becomes more creative & innovative -Willing to consider different options -=BSN nurse with ~2 years clinical experience.

How should the nurse promote a patient-centered interview?

-Visualize oneself as the nurse one wants to be. -Introduce yourself. -How would the patient like to be addressed? -Perform comfort measures (Temperature, privacy) -Maintain privacy/HIPAA -Give patient full attention -End by asking patient to summarize discussion/interaction

What are Nursing's scientific/scholarly forms of communication?

-Writing (Professional scholarly papers, clinical documentation) -Speaking (Scholarly presentations, clinical presentations, shift debriefing)

How should the nurse document the planning step?

-Written in future tense. Ex: The nurse will implement music therapy pre-operatively.

What are the two parts of the Nursing Diagnostic Written Statement?

1) Diagnostic Label 2) Related Factor

What are the three types of nursing interventions?

1) Nurse-Initiated Interventions 2) Healthcare Provider-Initiated Interventions 3) Collaborate/Inter-dependent Interventions

What are the 4 categories of Etiological/Related Factors?

1) Pathophysiological 2) Treatment-Related 3) Situational (environment or personal) 4) Maturational

What 6 important factors should be considered when choosing interventions?

1) Patient goals & expected outcomes 2) Characteristic of the nursing dx 3) Research basis for intervention 4) Feasibility for doing the intervention 5) Acceptability of the intervention to the patient 6) The nurse's own competency

What are the tenets characteristic of nursing practice?

1. Caring and health are central to the practice of the RN. 2. Nursing practice is individualized. 3. RNs use the nursing process to plan and provide individualized care for consumers. 4. Nurses coordinate care by establishing partnerships. 5. A strong link exists between the professional work environment and the RN's ability to provide quality health care and achieve optimal outcomes.

After the Nursing dx and/or collaborative problems have been identified by the RN, the RN will...

1. Prioritize the diagnosis 2. Help the patient identify patient-centered goals and expected outcomes.

What are the steps involved in implementing interventions?

1. Reassess the patient's health status. 2. Review and revise the existing NCP as needed. 3. Organize resources needed for care delivery. 4. Anticipate and prevent complications. 5. Implement nursing interventions. RROAI: Reach Right Over An Issue

When was the term Nursing Diagnosis first introduced in the nursing literature?

1950

What year was the first national conference on nursing diagnosis held? How many diagnoses were made?

1973 80 nursing diagnoses

What was NANDA-I established?

1980s

Patient Goal

A broad statement that describes a desired change in a patient's condition, perceptions, or behavior. Ex: The patient will ambulate. Mr. Franks will breathe on his own.

Problem-Focused Nursing dx

A clinical judgement concerning an undesirable human response to a health condition/life process.

Counseling

A direct care method that helps patients use problem-solving processes to recognize and manage stress and facilitate interpersonal relationships.

High Priority

A dx that if left untreated, results in harm to a patient (or others)

What is the nursing health history?

A key component of a comprehensive assessment; seeks to collect information on patient's history of disease/pathology/injury/etc. Addresses all health dimensions which will allow the RN to develop a patient-centered plan of care.

Scientific Method

A methodical way to solve problems using reasoning. 1. Identify problem 2. Collect data 3. Formulate hypothesis 4. Test hypothesis 5. Evaluate results of test

Lifesaving measure

A physical care technique that you use when a patient's physiological or psychological state is threatened. Purpose is to restore homeostasis.

Standing Order

A preprinted document containing orders for routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical problems.

Compassion Fatigue

A state of burnout and secondary traumatic stress.

Clinical practice guideline

A systematically developed set of statements that helps nurses, physicians, and other health care providers make decisions about appropriate health care for specific clinical situations.

Concept map

A visual representation that allows you to geographically show the connections among a patient's many health problems.

What is the goal of nursing?

Achieve positive patient outcomes in keeping with nursing's social contract with an obligation to society.

Collaborative Problem

Actual or potential physiological complication that nurses monitor and manage in collaboration with other healthcare professionals. Usually in acute care/inpatient setting.

What is an APRN?

Advanced Practice Registered Nurse -Clinical nurse specialist -Nurse Anesthetist (DNP required) -Nurse Midwife -Nurse practitioner Minimum education required is a master's degree in nursing.

Implementation begins...

After the NCP is developed.

What is the RN accountable for?

All patient care and outcomes of care, whether performed themselves or delegated to a nursing assistant/LPN.

According to NANDA, by whom are nursing diagnoses used?

All registered nurses regardless of nursing education.

Open-ended questions

Allows patient to tell his/her story; does not presuppose a specific answer. ("Please tell me how that made you feel.")

What is the ANA?

American Nurses Association; professional organization for all RNs. -Responsible for developing standards that apply to the practice for all professional nurses.

What is a competency?

An expected level of performance that integrates knowledge, skills, abilities, and judgement.

Short-term goal

An objective behavior or response that you expect a patient to achieve in a short time, usually less than a week.

Long-term goal

An objective behavior/response that you expect a patient to achieve over a longer period, usually several days/weeks/months.

Nursing Interventions

Any treatment or action based on clinical judgement and knowledge that nurses perform to enhance/facilitate patient outcomes. Selected to help a patient move from present health to level described in goal and measured by expected outcomes.

What is a nursing intervention?

Any treatment/action performed by a nurse based on knowledge and/or clinical judgement. Expected to be evidence-based. Direct and Indirect care measures.

What are the ANA standards of practice?

Authoritative statements of duties that all RNs, regardless of role, population, or specialty are expected to perform. Describe a competent level of nursing care.

What are the components of the Nursing health history?

Biographical Info Chief concern/reason for seeking care Patient expectations Present illness/health concerns Health history Family history Psychosocial history Spiritual health Review of systems

Analysis and interpretation of assessment data begin...

By organizing data into data clusters.

Correctly-written Expected Outcome

Carrie WILL CONTACT the family independence agency by phone by 10/17/2017 to set up an appointment.

Condition of Expected Outcome

Circumstances under which the person is to perform the actions.

How should the nurse document data?

Clear, concise manner using appropriate terminology. Include subjective and objective data. Report only data and be as descriptive as possible. DO NOT write your interpretation of what the data means.

Health Promotion Nursing dx

Clinical judgement concerning a patient's, family's, group's, or community's motivation and desire to increase well-being and actualize human health potential. *Use this dx when patient expresses readiness to enhance a specific health behavior.

Risk-for Nursing dx

Clinical judgement concerning the vulnerability of an individual, group, or community for developing an undesirable human response.

What are ineffective interviewing techniques?

Closed-Ended Questions Leading Questions

Validation

Comparison of data with another source to determine data accuracy.

Data Clusters

Comprised of objective and/or subjective signs, symptoms, and risk factors that, when analyzed holistically, lead to diagnostic conclusions.

According to NANDA, at what level are nursing diagnoses written?

Conceptual level

Burnout

Condition that occurs when perceived demands outweigh perceived resources.

Nurse Researcher

Conducts evidence-based practice and research

A critically-thinking nurse...

Considers what is important in a situation, and mentally explores alternatives, considers ethical principles, and then makes informed decisions regarding care in order to attain positive patient outcomes.

What is the purpose of documenting interventions implemented?

Creates legal record and is used to evaluate nursing care given.

What is the foundation of nursing practice?

Critical thinking

Healthcare Provider-Initiated Interventions

Dependent nursing interventions that require an "order" from a healthcare provider (MD/NP/etc.) Nurse intervenes by carrying out healthcare provider's written/verbal instructions. Ex: Administering medications

What is the focus of nursing?

Diagnosis and treatment of human response (not only disease/pathology)

When the nurse accurately identifies patterns of data, they form...

Diagnostic Conclusions

How should the nurse phrase the Diagnostic Statement?

Diagnostic label + etiology/related factor Acute pain RELATED TO trauma of surgical incision.

Leading Questions

Directs the respondent to give the answer he/she thinks you want. ("You wouldn't ever drink and drive, right?")

Undefined Quantities/Vague time periods

Do not use these when documenting interventions (A lot, some, too much; often rarely, frequently).

Low Priority

Dx that affects a patient's future well-being.

How should the nurse prepare the patient for an intervention?

Ensure the patient is physically and psychologically ready. -Create a favorable emotional climate (do not rush care, encourage family presence, allow time for questions) -Offer comfort measures (Pain medication, elimination need, noise, lighting)

Florence Nightingale

Established the first nursing philosophy based on health maintenance and restoration (1860). Developed the first organized program for training nurses (1860). First practicing nurse epidemiologist. "Lady with the lamp".

What are the standards of professional performance?

Ethics Culturally congruent practice Communication Collaboration Leadership Education Evidence-based practice and research Quality of practice Professional practice evaluation Resource utilization Environmental health

How does evaluation differ from assessment?

Evaluation focuses on the nursing care provided and the patient's response to the nursing care.

What are secondary sources?

Family, significant others, friends (via reports and responses)

How should the nurse sign his/her name when documenting?

First initial of first name, last name, and credentials. K. Applebee, RN

Mary Mahoney

First professionally-trained African American Nurse.

Clara Barton

Founder of the American Red Cross

What is the phenomenon of concern of nursing?

Health

What are the domains of nursing practice?

Helping role Teaching/coaching role Diagnostic & patient-monitoring role Effective management of rapidly-changing situations Administering/monitoring therapeutic interventions & regimens Monitoring/ensuring quality of healthcare practices Organizational and work-role competencies

What is a patient in nursing?

Holistic view; individuals, families, communities, populations.

Performance Criteria of Expected Outcome

How well the person performs the actions.

How should the nurse correct errors in the Diagnostic Label?

Identify patient response, not the medical diagnosis. Identify NANDA-I diagnosis, not a patient symptom Identify related factor treatable by nursing intervention, not something untreatable by a nurse **AVOID legally inadvisable statements that imply blame, negligence, or malpractice.

Modify the NCP

If the EO is not achieved, but new data/new nursing dx is revealed, or if interventions in the NCP are no longer appropriate/new ones have been identified that are better for attaining the EO.

Continue the NCP

If the EO is not achieved, but the interventions in the NCP are still appropriate.

Diagnostic Conclusions

Include issues/responses treating solely by nursing (Nursing dx), and issues/responses treated by nurses in collaboration with other healthcare professionals (collaborative problems)

Instrumental activities of daily living

Include skills such as shopping, preparing meals, housecleaning, writing checks, and taking medications.

Back-Channeling

Includes active listening, prompts, such as: Go on... Very interesting... Then what happened...

Nurse-Initiated Interventions

Independent interventions that a nurse initiates without directions from others. Autonomous actions based on scientific rationale. Ex: Turning a patient to prevent pressure ulcer formation.

Nursing is:

Independent, autonomous, scientific discipline. Patient-centered & outcome-focused

What levels can advocacy occur at?

Individual Interpersonal Organization/community Policy

Cue

Information you obtain through the use of your senses.

Hand-off

Interactive process of passing patient-specific info from one caregiver to another for ensuring patient-centered care and safety.

Thinking and learning about nursing are...

Interrelated, life-long processes.

Collaborative or Inter-dependent Interventions

Interventions that require the combined knowledge, skill, and expertise of multiple healthcare providers. Ex: Weaning a patient off of a ventilator.

Intermediate Priority

Involves non-emergent, non-life threatening needs of patients.

Prioritizing the nursing dx

Involves ranking the dxs/collab problems to establish importance. -This allows nurse to attend to most urgent needs and better organize care activities

How can nurses facilitate patient health and wellness outcomes?

Knowing how patients think & learn best; utilizing teaching/learning approaches that match the patient's style.

Evidence-based practice

Life-long problem-solving approach that integrates the best evidence from well-designed research studies and evidence based theories; clinical expertise and evidence from assessment of the health consumer's history and condition, as well as healthcare resources; and patient/family/group/community/population preferences & values.

Closed-Ended Questions

Limits the answer to one or two words, such as yes/no, or a number, etc. ("Do you ever drink/drive?")

Nurse Administrator

Manages patient care and the delivery of specific nursing services within a health care agency. Clinical care coordinator, nurse manager.

Nursing Diagnosis

NOT a medical diagnosis A clinical judgement made on the basis of information Classifies health issues within the domain of nursing Clinical judgement concerning a human response to health conditions/life processes that nurses are licensed/competent to treat.

NANDA-I

North American Nursing Diagnosis Association International. Develops, refines, and classifies nursing diagnoses.

What does the nursing care plan (NCP) include?

Nuring Diagnosis, Pt Goal and Expected Outcome, the planned and implemented nursing interventions, and evaluation.

What does critical thinking in nursing mean?

Nurses need to think of clinical situations using inquiring minds and as sources of data/information to facilitate positive patient outcomes.

What are non-APRNs that require Master's-level education?

Nursing Education Forensic Nursing Nursing Informatics

"Why" of nursing

Nursing's response to the changing needs of society to achieve positive healthcare consumer outcomes in keeping with nursing's social contract with an obligation to society.

Defining Characteristics

Observable assessment cues such as patient behavior, physical signs.

What are effective interview techniques?

Observation Open-ended questions Back-channeling

Objective Data

Observations of measurements of the patient's health status. -Measured on the basis of an accepted standard (e.g. fahrenheit scale) -What the nurse feels, sees, hears, smells. DO NOT use "seems" or "appears"

Observation

Observe nonverbal, such as eye contact, body language, tone of voice.

Reflection-in-action

Once you deliver an intervention, you continuously examine results by gathering subjective and objective data from a patient, family, and health care team members.

How is critical thinking acquired?

Only through experience and an active curiosity toward learning.

Terminate the NCP

Only when the EO is fully achieved.

What are the phases of an interview?

Orientation/setting an agenda Working phase - collecting assessment or nursing health history Terminating an interview

Chapters to review

PPSH 1, 15-20 ANA pp. 1-66

What are resources used to collect assessment data?

Patient Family/SOs/Friends Other healthcare team members Health care record

With what does the assessment begin?

Patient-centered interview

Patient adherence

Patients and families invest time in carrying out required treatments.

What is the difference between documenting the planning stage, and documenting the implementation stage?

Planning: Describes what the nurse plans to do to attain patient goal/EO (FUTURE TENSE). Implementation: Describes what the nurse actually did (PAST TENSE).

Quality and Safety Education for Nurses

QSEN; addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments.

What can a well-planned, comprehensive NCP do?

Reduces the risk for incomplete, incorrect, or inaccurate nursing care, enhances continuity of care, and facilitates attainment of expected outcomes.

What are the components of critical thinking?

Specific knowledge base Experience Competencies Attitudes Standards

What must the expected outcome be?

Specific/singular, measurable, attainable, realistic, time-specific, written in future tense.

THINK mnemonic

T - Total recall: Facts, the ability to access/retrieve info, requires memory H - Habits: Thinking approaches used frequently that become second nature I - Inquiry: Examining issues in depth and questioning the obvious N - New ideas / K - "Kreativity": Individualized way of thinking about phenomena

What is the focus of this course?

Teach you how to think as a nurse would.

Basic Critical Thinking

Tends to be concrete, task-oriented, and based on a set of rules/principles. -Accepts the values/beliefs/behaviors of other and believes experts have the right answers to every problem.

Diagnostic Label

The NANDA-I nursing diagnosis; describes the essence of the patient's response to health conditions succinctly.

What is the most commonly-used critical-thinking framework used by professional nurses?

The Nursing Process

ANA Standard 2: Diagnosis

The RN analyzes assessment data to determine actual or potential diagnoses, problems, and issues.

ANA Standard 1: Assessment

The RN collects pertinent data and info relative to the healthcare consumer's health or the situation. Deliberate and systematic collection of info about a patient

ANA Standard 5a. Coordination of Care

The RN coordinates care delivery.

ANA Standard 4: Planning

The RN develops a plan that prescribes strategies to attain expected, measurable outcomes.

ANA Standard 5b. Health Teaching and Health Promotion

The RN employs strategies to promote health & a safe environment.

ANA Standard 6: Evaluation

The RN evaluates progress toward attainment of goals and outcomes.

ANA Standard 3: Outcomes Identification

The RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.

ANA Standard 5: Implementation

The RN implements the identified plan.

Evaluation

The ability to assess the credibility, significance, and applicability of sources of information necessary to support conclusions.

Explanation

The ability to describe the assumptions that led to the conclusions reached.

Analysis

The ability to examine, organize, classify, and prioritize variables.

Inference

The ability to formulate hypotheses or draw conclusions based on evidence.

Self-Regulation

The ability to self-examine and self-correct.

Interpretation

The ability to understand and identify problems.

Advocacy

The act or process of pleading for, supporting, recommending a cause or course of action

Verb of Expected Outcome

The actions the person must take to achieve the outcome.

Diagnostic reasoning

The analytical process for determining a patient's health problems.

Related Factor

The etiology/causative factor for the diagnosis identified from the patient assessment data. Allow the nurse to individualize nursing care for the nursing diagnosis. Must be treatable NOT the medical diagnosis.

Expected Outcomes

The measurable change in response to the nursing care given that must be achieved to reach a goal.

Commitment

The nurse makes clinical decisions without assistance from others, and accepts accountability for decisions made. -Chooses an action based on the available alternatives, & supports it =Nurse expert with ~5 or more years clinical experience -Often the APRN

What is a primary source?

The patient (via interview, observation, examination)

Subjective Data

The patient's (or secondary source's) verbal descriptions of the health problems. Includes patient's feelings, perceptions, self-reports. NOT the nurse's interpretation of data. Document verbatim

What does the nurse evaluate?

The patient's response to the care given, and whether the nursing interventions implemented were successful in attaining the patient goals/expected outcomes (these are criteria against which the nurse judges success)

Critical thinking in nursing is always driven by...

The patient's/family's needs.

The NCP is implemented to address...

The seven domains of nursing practice

Genomics

The study of all the genes in a person and interactions of these genes with one another and with that person's environment.

"How" of nursing

The ways, means, methods, and manners nurses use to practice professionally.

Nursing occurs whenever...

There is a need for nursing knowledge, wisdom, caring, leadership, practice, or education (anytime/where).

Target Time Frame of Expected Outcome

Time/date by which the person is expected to be able to perform the actions.

Why does the nurse implement interventions?

To facilitate the attainment of patient goals/expected outcomes.

Indirect Care Interventions

Treatment/actions performed by the nurse away from the patient, but on behalf of the patient. Support the efficacy of direct care. Documentation, listening to change of shift report.

Direct Care Interventions

Treatments/actions performed by the nurse through direct interaction with patients. Medication administration, bathing, IV insertion.

True or False: Every Nursing Diagnosis requires its own Nursing Care Plan.

True

Reflection

Turning over a subject in the mind and thinking about it seriously. Purposeful thinking back or recalling a situation to discover its purpose/meaning.

Activities of Daily Living

Usually performed over the course of the day; include ambulation, eating, dressing, bathing, and grooming.

Types of thinking

Visual, Auditory, Performance-Based.

What should the nurse ask to assess why patient goals and EO(s) may not have been met?

Was the EO realistic? Was the patient/family involved in decision-making? Does the patient feel the outcome is important? Were all of the interventions performed?

Subject of Expected Outcome

Who is expected to achieve the outcome.

The scope of nursing practice describes the...

Who, what, where, when, why, and how of nursing practice