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154 Cards in this Set
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According to the 1965 American Nurses Association "First Paper on Education for Nursing", the essential components of professional nursing practice include... |
care, cure, and coordination |
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ANA definition of nursing |
Nursingis the protection, promotion, and optimization of health and abilities,prevention of illness and injury, alleviation of suffering through thediagnosis and treatment of human response, and advocacy in the care ofindividuals, families, communities, and populations. |
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National Council of State Boards of Nursing (NCSBN) guiding principles of nursing regulation? |
Protection of the public, competence of all practitioners regulated by the board of nursing, due process and ethical decision making, shared accountability, strategic collaboration, evidenced-based regulation, response to the marketplace and health care environment, globalization of nursing |
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Historical differences between nurses and medicine |
Medicine concerned with diagnosis and treatment (cure) of disease Nursing is concerned with caring for the person in a variety of health related situations Cure v. care |
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How can nursing be conceptualized as both an art and science? |
Art: compose of skills that require expertise, adeptness, and proficiency for their competent execution Science: Requires systematized knowledge derived from observation, critical thinking, study, and research |
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Characteristics of a profession according to Lucie Kelly, RN, PHD, FAAN |
ServicesProvided are vital to humanity and society Useof the Scientific Method to Enlarge the Body of Knowledge Serviceinvolves intellectual activities, accountability EducationWithin Institutions of Higher Education Controlof Professional Policy, Professional Activity, and Autonomy LifetimeCommitment motivated by service and altruism Codeof Ethics to guide decisions and conduct Encouragesand supports high standards of practice |
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What did the 1997 Woodhull Study on Nursing and the Media find? |
Discovered that nurses are virtually invisible in media coverage of health care |
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How much is employment of RNs projected to grow from 2014 to 2023. Why ? |
16%; aging populatiion, increased access to health care |
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Factors affecting nursing supply |
Limited number of spaces in nursing programs, cost of nursing programs, shortage of nursing faculty and clinical placements, retention of current nurses |
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What position do nurses rank for rates of muscloskeletal injuries resulting in missed work days? |
Rank fifth among all occupations |
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What percentage of needle stick injuries are sustained by nurses? |
One half |
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How did the nursing pin tradition come about? Nursing cap? Nursing uniform? |
Pin: maltese cross chosen by Florence Nightingale as symbol for the badge worn by the graduates of her first nursing school. Also used by US Cadet Nurse Corps Nursing cap: originated in the habit worn by the Sisters of Charity of St. Vincent de Paul Nursing uniform: originated from the religious and military history of nursing |
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What are the ANA standards of practice? |
Assessment, Diagnosis, Outcomes Identification, Planning, Implementation (Coordination of Care, Health Teaching and Promotion, Consultation, Prescriptive Authority and Treatment), and Evaluation |
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What is differentiated practice? |
The practice of structuring nursing roles on the basis of education, experience, and competence |
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How does critical care nursing encompass differentiated practice? |
Differentiated group professional practice including shared governance model, differentiated care delivery, and shared value |
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What are the shared governance model, differentiated care delivery, and shared value practices done by critical care nurses? |
Shared Governance Model: RNs have a voice and vote in their nurse practice Differentiated Care Delivery: RN practice is recognized as exampled by Advanced Practice Nurses and Clinical Nurse Specialists Shared value: recognition of excellence in practices for the bedside RNs in precepting, charge roles, leadership, and collaboration |
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The Council of Associate Degree Programs gives what 3 roles of nurses? |
1. Provider of Care 2. Manager of Care 3. Member within the discipline of nursing |
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What link did Dr. Linda Aiken find in 2003 about the relationship between nursing education and patient outcomes? |
Clear link between higher levels of nursing education and better patient outcomes; surgical patients treated in hospitals with a higher proportion of nurses educated at the BS or higher level have a substantial survival advantage |
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Clinical ladder systems are often incorporated within... |
differentiated nursing practice |
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Outcomes of differentiated nursing practice |
•Increased job satisfaction,decreased staffing costs, decreased nurse turnover rates, decrease in adverseevents, clear nursing roles, and improved patient interventions and outcomes |
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History of nursing assistants? Where do they provide the majority of care? How do they function? |
Began during WWII; provide majority of care in nursing homes; function under direction of RN or LPN |
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How did the Ombibus Budget Reconciliation Act impact nursing assitants? |
•all people working as nursing assistants in nursing homes are requiredto complete a minimum of 75 hours of theory and practice and pass anexamination to be certified. |
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Nursing Assistant Skills |
Changing bed linens.Taking vital signs.Bathing.Personal care.Tube feedingsEnemasAmbulationStable, unchanging clientsFeeding and exercising patients.Safety: safe environment and properuse of side rails, restraints, and patient rights.Home health aide assist individualswith basic care in their home (also grocery, cooking, and laundry) |
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Training for practical nurses |
•Typically takes 1 year to completethe training. •Stress clinical experience instructured care settings (hospitals and long term care).•High schools, trade or technicalschools, hospitals, community colleges.•Graduates take the NCLEX – PN exam |
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Roles of practical nurse |
•Scope of practice focuses on meeting the health care needs of clientsin hospitals, long term care facilities, and the home.•They care for patients whose conditions are stable.•Give direct patient care. •Observe, record and report.•Administer medications and treatments.•Assist in rehabilitation.Directed by an RN or a licensedphysician |
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Diploma education nursing education |
•Earliest type of Nursing Education.•Hospital based post secondary education programs. 27 to 36 months in duration.•Many are affiliated with a college or university so courses are transferable. •Modified apprenticeship model. •Strong emphasis on client experiences.•Nursing management. |
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What type of nursing education prepares more graduates for licensure as RN's than any other program? |
Associate degree education |
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What is the first and only type of nursing education established on the basis of planned research and experimentation? |
Associate degree education |
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Issues facing associate degree education for nurses |
Pressure to increase credits, increased enrollments, selective admission process |
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Characteristics of baccalaureate education? |
•Upper division nursing major that is built onto 2 years of liberal artsand science courses. •Must meet the entrance and graduation requirements of the university. •Basic nursing skills.•Health maintenance and promotion. •Disease prevention.•Supervisory and leadership techniques and practice.•Introduction to research. •Experience in public health nursing, community health setting, andleadership responsibility in acute care.•Emphasis on critical decision making skills, and exercising independentnursing judgments in complex situations.•Collaboration with other members of the health care team.•Supervision of others with less preparation. •Work with groups as well as individuals. |
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Process of reflective awareness to action |
Self-awareness-->self-advocacy-->advocacy for others-->reflective action |
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What did Hildegard Peplau propose in 1952? What is encompassed? |
Interpersonal Relations in Nursing--the therapeutic use of self; involving personality, communication, connectedness, humanistic energy, healing presence, and caring |
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Stages of the nurse-patient relationship |
Pre-interaction, orientation phase, working phase, termination phase |
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The orientation phase of the nurse-patient relationship involves... |
Introduction and assessment; gather information, define the problem, identify strengths; determine client's view of problem and identify strengths in resolution; use basic listening and attending, open ended questions, verbal cues, and leads |
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What is involved in the working identification phase of the nurse-patient relationship? |
Planning and implementation; determine the potential outcomes; discover how the client perceives the resolution and how they can achieve it; use basic listening and attending, giving feedback and influencing and encouraging feedback |
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What is involved in termination phase of nurse-patient relationship? |
Evaluation; generalization and transfer of learning; enable changes in thoughts, feelings, perception, and evaluate effectiveness of the changes the ability to self-care; influencing, feedback, and validating thoughts and feelings |
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Elements of communication |
Context: message, receiver, feedback, and sender |
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What are operations within the communication process? |
Perception, evaluation, transmission |
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Types of communication with their components |
Verbal: spoken speech Non-verbal: somatic language, action language |
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Keys to success in nursing |
Feedback (affirmation), Appropriateness, efficiency (KISS--keep it simple sweetie principle), Flexibility |
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What are the revolving thoughts in the nursing process? |
Empathy, open-ended questions, giving information, reflection, silence |
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What is SBAR communication and what is involved? |
S=Situation: be prepared with your name, credentials, hospital unit B=Background: patient, demographics, history A=Assessment: vitals, O2 stats, pain, pertinent information relevant to patients current status R=Recommendation |
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What are IOM recommendations for interprofessional communication? |
Improved communication verbally and in writing between professionals; needs to be accurate and as brief as possible |
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Key elements in leadership roles |
Collaboration, coordination, supervision, delegation |
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According to the Joint Commission, what % of nurses surveyed reported witnessing disruptive behavior? |
90% |
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Greenlead, 1973 described what aspects of servant leadership? |
0Listening0Empathy0Healing0Awareness0Conceptualization0Foresight0Stewardship0Commitment tothe Growth of People0BuildingCommunity |
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Aspects of teamwork |
Communication, coaching, patient satisfaction, servant leadership |
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Important factors with inter-professional communication |
Respect, clarify communication, respond professionally, constructive criticism, support system, documentation, follow up |
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What is TeamSTEPPS? |
Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals. |
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What is abandonment? |
Results when the nurse-patient relationship is terminated without making reasonable arrangements with an appropriate person so that nursing care by others can be continued |
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Differentiated scope of practice between RN and LPN |
Nursing diagnosis not within the scope of LPNs. LPNs in NY do not have assessment privileges, may not interpret patient data independently, may not triage, may not create, initiate, or alter nursing care goals or establish nursing care plans |
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What is the LPN scope of practice? |
Dependent role at direction of RN or other authorized health care providers. Administer meds, provide nursing treatments, gather patient measurements, signs, and symptoms. |
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Can LPNs practice IV therapy in acute care settings? |
Requires RN supervision; RN must document patient's condition (at least every shift) condition relative to IV therapy |
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Can LPNs practice IV therapy in long term care settings? |
Requires RN supervision; RN must document patient's condition (at least every shift) condition relative to IV therapy |
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What are the legal circumstances in which orders for a patient population with whom an authorized provider has no treatment relationship can be made? |
Non-patient specific standing orders for the administration of immunization, anaphylactic agents, purified protein derivative tests, and HIBV tests |
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What is the mandatory overtime law of 2008? |
¢Thisnew law will prohibit health care facilities from requiring nurses to work morethan their regularly scheduled work hours, but does not place a specific cap onthe number of hours that can be worked per day or week. The bill containsexceptions to the mandatory overtime prohibition for the followingsituations:¢Naturalor other types of disasters that increase the need for nursing services, ¢Afederal, state or county declaration of emergency, ¢Anurse engaged in an ongoing medical or surgical procedure, ¢Whennecessary to provide safe patient care where no other alternative staffing isavailable; and Anurse voluntarily agrees to work overtime. |
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What is the whistleblower protection that was passed in 2002? |
protects employees, who provide healthcare services, from retaliatory action by their employers when the employeediscloses or refuses to participate in activities s/he believes constitutesimproper quality of patient care. |
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What is the professional assistance program? What is it called for nurses? |
allows licensees who abuse alcohol orother drugs to surrender their licenses voluntarily and confidentially whileprogressing through an acceptable course of treatment; it is available tolicensees who have not harmed clients. Successful completion of the program mayact as an alternative to disciplinary action SPAN: Statewide Peer Assistance for Nurses |
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What is malpractice? |
®Malpracticeis negligence applied to the acts of a professional.®Malpracticeoccurs when a professional fails to act as a reasonably prudent professionalwould have acted in similar circumstances. |
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How is a determination of malpractice made for a nursE? |
Nurse's actions will be judged against the nursing standard of care |
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What is the plan of correction for harm to patients? |
1. Correcting the harm to the individual affected 2. Ensuring the same harm is not occurring to others 3. What is the plan to ensure the deficient practice is not going to be done by others? 4. How is the deficient practice going to be monitored in an ongoing manner through quality assurance plan? |
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reasons documentation is important |
Legality, reimbursement, regulatory standards, communicate, quality assurance |
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What are possible charting formats? |
POR: problem oriented record SOAP: subjective, objective, assessment, plan PIE: problem, intervention, evaluation Charting by exception Focus charting: DAR--data, action, response |
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What is problem oriented record? |
¢Focuson the client’s health problems¢Numericlist of medical problems ¢Nursesrefer to the problem by number and chart observations by referring to thelisted problem by number, name or both |
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What is charting by exception? When is it best used? |
•Basedon policy and procedure for standards of care•Wellsuited for critical pathways•UsesFLOW SHEETS with parameters written and categories pre-defined•Nursescan “check” normal, abnormal, and then deviations from normal have to havefurther clarification via narrative notes or a space on the form |
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What is involved in focus charting/DAR notes? |
Data: Subjective and objective assessment, client behaviors, status and nursing observation to substantiate the strength or weakness (the focus) Action: Nursing plan and interventions, nursing orders of the focus Response: evaluation of client's response through client database, flow sheets, graphs, and checklists |
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Types of medical orders |
Written orders, faxed orders, standing orders, verbal orders |
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What are standing orders? Some typical examples? |
¢Providersmay have agency specific guidelines for standard orders that nurses mayadminister medications or treatments or follow certain protocols under certaincircumstancesAdministeringPPDs to new employeesAdministeringFlu Vaccine to all patientsAcetominophenfor temp >101 or complaints of malaise |
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Process of verbal orders |
®TheNurse transcribes the prescribers orders onto an orders sheet (V.O)®Legally,these orders must be signed by the prescribers within a standard time frame |
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Definition of ethics |
}Thebranch of philosophy that concerns the distinction between right and wrong onthe basis of a body of knowledge, not just on the basis of opinions. Refers to actions an individual would take |
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Definition of morals |
Established rules of conduct; used in situations where decisions about right and wrong must be made; provide standards of behavior that guide actions of an individual or social group |
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Definition of values |
}Attitudes,ideals, beliefs}}Heldand used to guide behavior}}Learnedover time}}Influencedby life experiences and culture}}Freelychosen}}Indicatewhat the individual considers important |
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Moral reasoning |
Psychological interpretative process that helps to connect one's more values with one's ethical choices |
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Core principles of nursing |
vdoing goodvvavoiding harmvvtelling the truthvvkeeping promisesvvtreating persons fairlyvvrespecting privileged datavvself-determination |
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Moral principles include: |
respect for autonomy, nonmaleficence, beneficence, justice |
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Three conditions of autonomous actions |
Intentionality, Understanding, Absence of controlling influences |
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What is nonmaleficence? |
Doing no harm: reasonable consideration of benefit, lack of excessive cost, pain, or other incoveniences First principle in human interaction |
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What is involved with beneficence? How can nurses add to this? |
Preventing harm, removing harm, doing good, balancing risks, harms, benefits, and effectiveness Nurses volunteering, using therapeutic communication with a patient |
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What is justice? Distributive justice? |
Fairness, giving to an individual their due (claim or entitlement) Distribution of benefits and burdens to each person: equal share according to individual need, effort, and societal contribution |
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What is veracity? What are common issues/conflicts? |
Truth-telling: to patients, to third-parties Not telling "whole" truth, misleading, withholding |
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What is fidelity? |
Faithfulness, keeping promises, honoring commitments |
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What is Immaneuel Kant's Deontology Theory? |
Process oriented, decisions are made based on the nurse's principles and consistent decisions; right or wrongs are determined by the inherent moral significance of the person, not the outcome; acts are moral if they originate from good will |
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What is Jeremy Bentham and John Stuart Mill's Utilitarian Theory? |
Outcome oriented, act utilitarianism or rule utilitarianism, greatest good or least harm for the greatest number, moral rightness is determined only by the consequence |
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Act utilitarianism v. rule utilitarianism |
Act: the end result is obtained no matter what Rule: The end result/decisions are made based on policy, law, and within context of being fair to the majority of those effected |
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What is Aristotle, and Alasdair MacIntyre's virtue theory? |
Person oriented, addresses moral life and values, based on faith, hope. honesty, charity, and wisdom; moral goodness or badness is addressed in terms of the moral value attributed to the character trait or virtue |
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Steps in ethical decision making |
Clarify, gather additional information, identify options, make a decision, act, evaluate |
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Types of advanced directives |
Health care proxy/agent; living will; MOLST; life sustaining treatment |
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What is health care proxy? |
Legal document that lets you name someone to make decisions about your medical care, including decisions about life support--if you can no longer make decisions and speak for yourself |
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What is a living will? |
Lets you state your wishes about medical care in the event that you develop an irreversible condition that prevents you from making your own medical decisions |
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What is the MOLST form? |
Medical Orders for Life Sustaining Treatment; translates patient/resident goals and preferences into medical orders; is based on communication between the patient/resident or surrogate and health care professionals that ensures informed medical decision making |
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ANA Code of Ethics: Provision 1-3 involve... Provisions 4-6 involve... Provisions 7-9 involve... |
Fundamental values and commitments of the nurse; boundaries of duty and loyalty; duties to the broader community |
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What is tort? |
A wrong that is committed bysomeone who is legally obligated to provide a certain amount of carefulness inbehavior to another and that causes injury to that person, who may seekcompensation in a civil suit for dam`ages |
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Order of how culture is learned |
First in family, then school, then in community and other social organizations (such as the church) |
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Primary characteristics of culture |
nationality, race, color, gender, age, religious affiliation |
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Secondary characteristics of culture |
Educational status, socioeconomic status, occupation, military experience, political beliefs, urban v. rural residence, enclave identity, marital status, parental status, physical characteristics, sexual orientation, gender issues, reason for migration, amount of time away from country of origin |
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What is culture and what is involved? |
Culture is a learned, patterned behavioral response acquired over time accepted by a community of individuals May involve implicit v. explicit beliefs, attitude, values, customs, norms, taboos, arts and life ways |
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What is multiculturalism? |
Diverse cultures coexisting within one world, groups have equal value |
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What is acculturation? |
Incorporating some of the cultural attributes of the larger society by diverse groups, individuals, and peoples |
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What is assimilation? |
Related to acculturation but is more complete adoption of the behaviors, beliefs, norms, and language of the dominant culture |
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What is subculture? |
Social group of people within the dominant culture who have different norms, behaviors, etc. that do not closely follow the dominant culture |
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What is health disparity? |
Differencesin the incidence, prevalence, mortality and burden of disease and other adversehealth conditions that exist among specific population groups in the UnitedStates |
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What is cultural relativism? |
Cultures are neither better nor worse, just different from one another |
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What is ethnicity? |
Social group of people who share common racial. geographic, religious, or historical culture; a conscious choice and awareness of a commitment to cultural identity; social concept, not a biological one |
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What is ethnocentrism? |
Belief that one's own culture is superior, not respecting the culture of others, stereotyping others, a form of discrimation |
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Positive aspect of ethnocentrism |
Responsible for cultural self-survival and helps people maintain self worth and self survival |
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What is the cultural assessment sequence? |
Three step process to determine the meaning of their health seeking and healthcare behaviors: general assessment, problem specific assessment, culture specific details |
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What is the LEARN style of culturally based teaching? |
Listen, explain (what you think the client said), acknowledge (the similarities and differences between both persons and perception), recommend, negotiate (mutually acceptable treatment, intervention, or resolution) |
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What is a culture of long-term deprivation called? |
Culture of poverty |
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Aspects of Purnell's Model for Cultural Competence. What is the center of the model? |
Community, Family, Person, Health Represents unknown phenomena, practices, and characteristics of the individual and group |
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What is Madeline Leininger's theory of transcultural nursing? |
Aclient who experiences nursing care that fails to be reasonablycongruentwith his/her beliefs, values, and caring lifeways will showsignsof cultural conflict, noncompliance, stress and ethical or moralconcern. |
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What is Giger and Davidhizar's Model of Transcultural Nursing? |
Focuses on assessment and intervention from a transcultural nursing perspective: communication, space, social orientation, time, environmental control, biological variations |
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How did Rothwell define a group? |
A human communication system composed of three or more individuals, interacting for the achievement of some common goal(s) who influence and are influenced by each other |
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Categories of groups |
Primary: spontaneous, informal (ex. family, friend group) Secondary: planned, time-limited, purpose identified, structured |
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Specific types of secondary groups |
1.Focus2.Therapy3.Activity4.Work groups5.Interdisciplinary health teams, 6.Health Educational groups |
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Stages/Phases of Group Development |
Forming, Storming, Norming, Performing, Adjourning |
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What is involved in the forming stage of group development? |
Inclusion, Orientation (acceptance, anxiety, superficial, development of trust) |
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What is involved in the storming phase of group development? |
Counterdependence, integrating individuals with group goals (power and control issues, behaviors emerge, uncomfortable, control ineffective group behaviors) |
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What is involved in the norming phase of group development? |
Cohesion; standards set (feedback spontaneous, accepted behavioral standards formed, increased accountability, apathy is scrutinized) |
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What is the performing stage of group development? |
Interdependence, sharing and working toward goals--accomplishing work, cohesiveness, affirmation |
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What is involved in the adjourning phase of group development? |
Independence, summarizing--plans for future growth, summation |
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Non-functional self-roles |
Aggressor, blocker, joker, avoider, self-confessor, recognition |
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Aspects group conflict |
Confrontation/collaboration; bargaining; competition; accommodation |
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Group anxiety includes |
scapegoating, acting out, projection/blaming, dependency/withdrawal/passivity, being very critical or very apathetic |
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Characteristics of effective groups |
Leadership style meets the group's aims; power is recognized, utilized appropriately, strong sense of responsibility and accountability, thought out decision making, positive and effective interaction patterns, group cohesiveness, strong group identity |
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Characteristics of ineffective group |
No group identity, lack of group cohesiveness,, poor interaction patterns, lack of decision making, little responisbility and accountability, ineffective leadership styles, power is used and abused and no attention to the powerless |
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How did the Industrial Revolution affect health care? |
Created crowded workplaces that were breeding grounds for disease |
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Describe how Florence Nightingale influenced the nursing profession in the 1850s. |
she organized a school of nursing because she believed nursing education was vital; she developed the profession so it was not seen to contain only subordinate females; she was religious |
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Why is there still an increase in diploma schools of nursing despite all of the changes in nursing education? |
Employers feel as though degree programs are not meeting the needs of nursing staff. |
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What has led to a smaller applicant pool for nursing students? |
Lack of nursing faculty |
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ANA standards of practice include... |
Assessment, outcomes identification, evaluation |
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Knowledge workers in healthcare acknowledge that change... |
inevitable in healthcare |
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What did Isabel Hampton Robb do as the first president of the American Nurses Association? |
Organized the nursing profession at the national level |
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What does belonging to a professional nursing association do for the nurse? |
It allows nurses to be nationally/locally active and improve leadership skills. |
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What do knowledge workers use while serving as a nurse? |
coordination, collaboration, and critical thinking |
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The nurse practices nondirective listening during which of the following phases of the nurse-client relationship? |
Orientation |
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Who developed the theory of Social Learning Theory? |
Bandura |
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What theory did Erik Erikson develop? |
Psychosocial development |
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Peplau described the third stage of self-development as: |
Matching of behavior with appraisals |
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What term best describes a team composed of members from varied disciplines that work together to achieve a common goal? |
Interdisciplinary |
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John, a member of a support group, has noticed that over the past few weeks the group has not been ending on time and that some members have been pairing off to discuss group issues. He brings this up with the group for discussion. This is an example of which maintenance function? |
Standard setting |
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According to the IOM, work in interdisciplinary teams refers to: |
Collaboration, Communication, Coordination |
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Personal values are defined as: |
Values taught by one's culture |
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What process helps the nurse to frame patient problems within the patient’s own cultural context? |
Clinical reasoning |
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ANA standards of professional nursing care |
Assessment, diagnosis, outcomes identification, planning, implementation (coordination of care, health teaching, consultation), evaluation |
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Elements of malpractice |
Proximate cause, damages or injury, duty to the patient, duty is breached |
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Nursing care process |
Assessment, Diagnosis, Planning, Implementation, Evaulation-- Constant re-evaluation |
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Interdisciplinary/inter-professional vs. multidisciplinary |
people with distinct disciplinary training working together for a common purpose as they make different, complementary, to patient focused care a team or collaborative process where members of different disciplines assess or treat patients independently and then share information with each other |
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Five rights of delegation |
Right task, right circumstance, right person, right direction/communication, right supervision |
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Boards of Nursing |
State governmental agencies responsible for the regulation of nursing practice in each respective state |
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Nurse Practice Acts |
Legal documents that communicate professional nursing scope of practice |
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Peplau's six nursing roles |
Stranger role, resource role, teaching role, counseling role, surrogate role, leadership role |
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CARE acronym |
C=connect; A=appreciate; R=respond; E=empower |
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Functional similiarity |
Defined as choosing group members who have enough in common intellectually, emotionally, and experientially to interact with each other in a meaningful way` |
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Four styles of personal conflict management |
Avoidance, accommodation, competition, collaboration |
