Podcast
Questions and Answers
What is the primary goal of the planning phase of the nursing process?
What is the primary goal of the planning phase of the nursing process?
Which of the following is an example of an advocacy intervention?
Which of the following is an example of an advocacy intervention?
What is the primary role of a Nurse Practitioner?
What is the primary role of a Nurse Practitioner?
Who established the first nursing philosophy based on health maintenance and restoration?
Who established the first nursing philosophy based on health maintenance and restoration?
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What is the main goal of health teaching and health promotion?
What is the main goal of health teaching and health promotion?
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In what year did Florence Nightingale establish the first nursing philosophy?
In what year did Florence Nightingale establish the first nursing philosophy?
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What is the primary responsibility of a nurse in the implementation phase?
What is the primary responsibility of a nurse in the implementation phase?
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What is the primary goal of the evaluation phase?
What is the primary goal of the evaluation phase?
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Who is responsible for providing primary, acute, and specialty health care to patients?
Who is responsible for providing primary, acute, and specialty health care to patients?
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What is the primary role of a nurse in the coordination of care?
What is the primary role of a nurse in the coordination of care?
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Which of the following historical events marked a significant turning point in the development of nursing education?
Which of the following historical events marked a significant turning point in the development of nursing education?
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What is the primary focus of the Quality and Safety Education for Nurses (QSEN) initiative?
What is the primary focus of the Quality and Safety Education for Nurses (QSEN) initiative?
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Which of the following is a key aspect of patient-centered care?
Which of the following is a key aspect of patient-centered care?
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What is the primary goal of the American Nurses Association's (ANA) Center for Ethics and Human Rights?
What is the primary goal of the American Nurses Association's (ANA) Center for Ethics and Human Rights?
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Which of the following historical figures played a significant role in the development of nursing during the Civil War era?
Which of the following historical figures played a significant role in the development of nursing during the Civil War era?
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What is the primary focus of the Magnet Recognition Program?
What is the primary focus of the Magnet Recognition Program?
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Which of the following is a key characteristic of the nurse's role in the 21st century?
Which of the following is a key characteristic of the nurse's role in the 21st century?
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What is the primary goal of informatics in healthcare?
What is the primary goal of informatics in healthcare?
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Which of the following is a key aspect of professional practice evaluation in nursing?
Which of the following is a key aspect of professional practice evaluation in nursing?
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What is the primary focus of the American Nurses Association's (ANA) Standards of Practice?
What is the primary focus of the American Nurses Association's (ANA) Standards of Practice?
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What is a fundamental aspect of professional nursing practice?
What is a fundamental aspect of professional nursing practice?
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Which of the following best describes the competent level of a nurse?
Which of the following best describes the competent level of a nurse?
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What is the primary purpose of the American Nurses Association (ANA)?
What is the primary purpose of the American Nurses Association (ANA)?
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What is the nursing process also known as?
What is the nursing process also known as?
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What is a characteristic of an expert nurse?
What is a characteristic of an expert nurse?
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What is essential for delivering quality patient-centered care?
What is essential for delivering quality patient-centered care?
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What is the main focus of primary health care?
What is the main focus of primary health care?
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What is the main purpose of discharge planning?
What is the main purpose of discharge planning?
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What is the main challenge facing nursing due to the aging baby boomer generation?
What is the main challenge facing nursing due to the aging baby boomer generation?
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What is the primary goal of patient-centered care?
What is the primary goal of patient-centered care?
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What is the main purpose of the Magnet recognition program?
What is the main purpose of the Magnet recognition program?
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What is the main purpose of telemedicine?
What is the main purpose of telemedicine?
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What is the main focus of restorative care?
What is the main focus of restorative care?
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What is the main challenge facing nursing due to the shortage and uneven distribution of physicians?
What is the main challenge facing nursing due to the shortage and uneven distribution of physicians?
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What is the main purpose of health promotion programs?
What is the main purpose of health promotion programs?
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What is the main challenge facing nursing due to the uncertainty of healthcare reform?
What is the main challenge facing nursing due to the uncertainty of healthcare reform?
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What is the primary purpose of the Patient Protection and Affordable Care Act (PPACA)?
What is the primary purpose of the Patient Protection and Affordable Care Act (PPACA)?
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What is the main purpose of the Health Information Technology Act?
What is the main purpose of the Health Information Technology Act?
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What is the primary purpose of the Uniform Anatomical Gift Act?
What is the primary purpose of the Uniform Anatomical Gift Act?
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What is the primary goal of Healthy People 2030?
What is the primary goal of Healthy People 2030?
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What is the primary purpose of the Emergency Medical Treatment and Active Labor Act?
What is the primary purpose of the Emergency Medical Treatment and Active Labor Act?
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According to the World Health Organization, what is the definition of health?
According to the World Health Organization, what is the definition of health?
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What is the primary purpose of the Nurse Practice Act?
What is the primary purpose of the Nurse Practice Act?
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What is the primary focus of secondary prevention?
What is the primary focus of secondary prevention?
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What is the primary purpose of the Health Insurance Portability and Accountability Act (HIPAA)?
What is the primary purpose of the Health Insurance Portability and Accountability Act (HIPAA)?
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What is the primary purpose of the Americans with Disabilities Act (ADA)?
What is the primary purpose of the Americans with Disabilities Act (ADA)?
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What is the primary role of the Health Belief Model?
What is the primary role of the Health Belief Model?
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What is the primary influence of internal variables on health?
What is the primary influence of internal variables on health?
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What is the primary purpose of the Mental Health Parity and Addiction Equity Act?
What is the primary purpose of the Mental Health Parity and Addiction Equity Act?
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What is the primary purpose of the Patient Self-Determination Act?
What is the primary purpose of the Patient Self-Determination Act?
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What is the primary role of the Holistic Health Model?
What is the primary role of the Holistic Health Model?
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What is the primary purpose of the Uniform Determination of Death Act?
What is the primary purpose of the Uniform Determination of Death Act?
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What is the primary goal of illness prevention?
What is the primary goal of illness prevention?
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What is the primary role of risk factor identification?
What is the primary role of risk factor identification?
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What is the primary influence of external variables on health?
What is the primary influence of external variables on health?
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What is the primary goal of the Transtheoretical Model of Change?
What is the primary goal of the Transtheoretical Model of Change?
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Study Notes
Nursing as a Profession
- To act professionally, a nurse must use critical thinking skills, administer quality patient-centered care, and be responsible and accountable.
- Nursing requires current knowledge and practice standards, an insightful and compassionate approach, and critical thinking and clinical judgment.
Benner's Model of Nursing Practice
- Benner's model describes the stages of nursing development, from novice to expert.
- The five stages are:
- Novice: Beginner nurse student with no nursing experience.
- Advanced Beginner: Some level of experience, maybe only observational.
- Competent: A nurse who has been in the same clinical position for 2-3 years.
- Proficient: A nurse with more than 2-3 years of experience.
- Expert: A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem.
American Nurses Association (ANA)
- The ANA is the professional organization for nurses in the United States.
- The ANA publishes standards of practice and performance for nursing, including:
- Standards of Professional Nursing Practice.
- Standards of Professional Performance.
- Code of Ethics.
Nursing Process
- Also known as the "Nursing Process," a model for clinical decision making.
- The six stages of the nursing process are:
- Assessment.
- Diagnosis.
- Outcomes Identification.
- Planning.
- Implementation.
- Evaluation.
Professional Responsibilities and Roles
- Autonomy and accountability.
- Caregiver.
- Advocate.
- Educator.
- Communicator.
- Manager.
Historical Influences
- Florence Nightingale:
- Established the first nursing philosophy (Nursing Theory) based on health maintenance and restoration.
- Organized the first program for training nurses.
- First practicing epidemiologist.
- Improved sanitation in battlefield hospitals.
- Practices remain a basic part of nursing today.
- Other historical figures, such as Clara Barton, Dorothea Dix, and Mary Mahoney, contributed to the development of nursing.
Contemporary Influences
- Quality and Safety Education for Nurses (QSEN):
- Patient-centered care.
- Teamwork and collaboration.
- Evidence-based practice.
- Quality improvement.
- Safety.
- Informatics.
Professional Registered Nurse Education
- Prelicensure education:
- 2-year associate's degree.
- 4-year bachelor's degree.
- Graduate education:
- Master's degree, advanced practice RN.
- Doctoral preparation.
- Continuing and in-service education.
Nursing Practice
- Nurse Practice Acts (NPAs):
- Regulate the scope of nursing practice.
- Protect public health, safety, and welfare.
- Licensure and certification.
- Requirements vary by state.
Health Care Delivery System
- Four challenges facing nursing:
- Aging baby boomer generation.
- Shortage and uneven distribution of physicians.
- Rate of nurses' retirements.
- Uncertainty of health care reform.
- Traditional levels of health care:
- Preventative.
- Primary.
- Secondary.
- Tertiary.
- Restorative.
- Continuing health care.
- Integrated health care delivery:
- Primary and preventive health care services.
- Secondary and tertiary care.
- Restorative care.
- Continuing care.
Health and Wellness
- Healthy People 2030:
- Provides evidence-based, 10-year national objectives for promoting health and preventing disease.
- Identifies leading health indicators which are high-priority health issues in the United States.
- Definition of Health:
- A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.
- A state of being that people define in relation to their own values, personality, and lifestyle.
- Models of Health and Illness:
- Health Belief Model.
- Health Promotion Model.
- Maslow's Hierarchy of Needs.
- Holistic Health Model.
- Variables Influencing Health and Health Beliefs and Practices:
- Internal variables.
- External variables.
Illness
- Definition of Illness:
- A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired.
- Acute illness.
- Chronic illness.
- Illness Behavior:
- Involves how people monitor their bodies and define and interpret their symptoms.
- Variables influencing illness and illness behavior.
- Impact of Illness on the Patient and Family:
- Behavioral and emotional changes.
- Impact on body image.
- Impact on self-concept.
- Impact on family roles.
- Impact on family dynamics.
Caring for Yourself
- Eat a nutritious diet.
- Get adequate sleep.
- Engage in exercise and relaxation activities.
- Establish a good work-family balance.
- Engage in regular nonwork activities.
- Develop coping skills.
- Allowing personal time for grieving.
- Focus on spiritual health.
- Find a mentor.
Legal Implications in Nursing Practice
- Legal Limits of Nursing:
- Sources of law.
- Scope and standards of nursing.
- Standards of nursing care.
- Federal Statutes Affecting Nursing Practice:
- Patient Protection and Affordable Care Act (PPACA).
- Emergency Medical Treatment and Active Labor Act.
- Health Insurance Portability and Accountability Act (HIPAA).
- Health Information Technology Act.
- Americans with Disabilities Act (ADA).
- Mental Health Parity and Addiction Equity Act.
- Patient Self-Determination Act.
- Uniform Anatomical Gift Act.
- The Omnibus Budget Reconciliation Act (1986).
- State Statutes Affecting Nursing Practice:
- Nurse practice acts.
- Health care acts and informed consent.
- Good Samaritan laws.
- Public health laws.
- Termination of pregnancy.
- Physician-assisted suicide.
- The Uniform Determination of Death Act.
- Nursing Workforce Guidelines:
- Staffing and nurse-to-patient ratios.
- Nursing assignments.
- Patient abandonment.
- Nurse delegation.
- Nursing students.
- Legal Implications and Reducing Your Legal Risks:
- Torts.
- Negligence.
- Malpractice.
- Malpractice insurance.
- Nurse experts.
- Reducing legal risks.
- Risk management and performance/quality improvement.
- Professional involvement.### The Need for Evidence-Based Practice
- Evidence-based practice (EBP) is a problem-solving approach to clinical practice that combines the best evidence with a clinician's expertise, patient preferences and values, and healthcare resources in making decisions about patient care.
- The best scientific evidence comes from well-designed, systematically conducted research studies found in scientific, peer-reviewed journals.
- Steps of evidence-based practice:
- Cultivate a spirit of inquiry
- Ask a clinical question in PICOT format
- Search for the best evidence
- Critically appraise the evidence
- Integrate the evidence
- Evaluate the outcomes of practice decision or changes
- Communicate the outcomes of the evidence-based practice decision
- Cultivating a spirit of inquiry involves constantly questioning current practices, leading to consistent use of EBP.
- Asking a clinical question in PICOT format involves identifying the patient population, intervention, comparison, outcome, and time.
- Searching for the best evidence involves using sources such as agency policy, procedure manuals, quality improvement data, existing clinical practice guidelines, and journal articles.
- Critically appraising the evidence involves synthesizing or combining the findings, considering the scientific rigor of the evidence, and determining the value, feasibility, and usefulness of the evidence.
- Integrating the evidence involves applying the research in a patient's plan of care, using evidence as rationale, and incorporating the change into policies and procedures.
- Evaluating the outcomes of practice decision or change involves determining whether the change was effective, if modifications are needed, and if the change should be discontinued.
Scientific Method
- The scientific method involves:
- Making an observation
- Asking questions and gathering information
- Analyzing the literature and forming a research question or hypothesis
- Conducting a study using scientific rigor
- Analyzing the data and drawing conclusions
- Types of research studies:
- Quantitative research: Experimental research, nonexperimental research, surveys
- Qualitative research: Inductive reasoning
Nursing Research
- Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively.
- Many professional and specialty nursing organizations support the conduct of research for advancing nursing science.
- Translation research phases:
- Preclinical and animal studies: Basic science research
- Phase 1 clinical trials: Testing safety and efficacy in a small group of human subjects
- Phase 2 and 3 clinical trials: Testing safety and efficacy in a larger group of human subjects and testing for comparison to standard treatment
- Phase 4 clinical trials and outcomes research: Translation to practice
- Phase 5 population-level outcomes research: Translation to community
- Outcomes research helps patients, healthcare providers, and those in healthcare policy make informed decisions on the basis of current evidence.
- The conduct of nursing research involves studying nursing questions and problems in greater depth within the context of nursing.
Performance Improvement
- Performance improvement (PI) is a formal approach for the analysis of healthcare-related processes.
- PI reviews how existing interventions within a process function.
- PI combined with EBP is the foundation for excellent patient care and outcomes.
- Performance improvement programs focus on processes or systems that significantly contribute to outcomes.
The Relationship Among EBP, Research, and PI
- Although EBP, research, and PI are closely related, they are separate processes.
- EBP uses information from research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes.
- Research involves systematic inquiry that answers questions, solves problems, and contributes to the generalizable knowledge base of nursing.
- QI improves local work processes to improve patient outcomes and health system efficiency; results are usually not generalizable.
Caring in Nursing Practice
- AONE Guiding Principles for Future Care Delivery
- Theoretical views on caring:
- Leininger's Transcultural Caring
- Watson's Transpersonal Caring
- Swanson's Theory of Caring
- Common themes among nursing caring theories:
- Caring is highly relational
- Caring is obvious when it is absent
- Enabling is an aspect of caring
- Knowing the context of a patient's illness helps choose and individualize interventions that will actually help the patient### Patient's Perspective of Caring
- Patients value the affective dimension of nursing care
- Caring Assessment Tool measures patients' perceptions of caring
- Patients become active partners in the plan of care when they sense healthcare providers are sensitive, sympathetic, compassionate, and interested in them as people
Ethic of Care
- Caring is an interaction of mutual respect and trust
- An ethic of care is concerned with relationships between people and a nurse's character and attitude toward others
Caring in Nursing Practice
- Caring is one of the human behaviors that can be given and received
- Recognize the importance of self-care and use caring behaviors to reach out to colleagues and care for them as well
Providing Presence
- Providing presence is a person-to-person encounter conveying a closeness and sense of caring
- Presence involves "being there" and "being with"
- Nursing presence is the connectedness between a nurse and a patient
- Establishing presence strengthens the ability to provide effective patient-centered care
Touch
- Provides comfort and creates a connection
- Types of touch: noncontact, contact, task-oriented, caring, and protective touch
- Use touch with discretion as it conveys many messages
Listening
- Necessary for meaningful interactions with patients
- True listening leads to knowing and responding to what really matters to a patient and family
- Listen effectively by silencing yourself and listening with an open mind
- Through active listening, truly know your patients and what is important to them
Knowing the Patient
- The core of clinical decision making and patient-centered care
- Two elements that facilitate knowing are continuity of care and clinical expertise
- Factors of knowing include time, continuity of care, teamwork of the nursing staff, trust, and experience
Spiritual Caring
- Spiritual health is achieved when a person can find a balance between life values, goals, and belief symptoms and those of others
- Spirituality offers a sense of intrapersonal, interpersonal, and transpersonal connectedness
Relieving Symptoms and Suffering
- Reducing symptoms and suffering requires caring nursing actions that give a patient comfort, dignity, respect, and peace
- Convey a quiet, caring presence, touch, or listen to assess and understand the meaning of a patient's discomfort
Family Care
- Caring for an individual includes their family
- Help family caregivers be active participants
- Understand the stress a patient's illness places on family members
The Challenge of Caring
- Challenges: task-oriented biomedical model, institutional demands, time constraints, reliance on technology, cost-effective strategies, and standardized work processes
- Health care must become more compassionate to make a positive difference
Scientific Knowledge Base
- Environmental safety: basic human needs, common environmental hazards, transmission of pathogens
- Factors influencing patient safety: developmental stages and risks, individual risk factors, and risks in health care agencies
Nursing Knowledge Base
- Factors influencing patient safety: developmental stages and risks, individual risk factors, and risks in health care agencies
- Risks in health care agencies: procedure-related accidents, equipment-related accidents, chemical exposure, falls, and workplace safety
Nursing Process
- Assessment: through the patient's eyes, nursing history and examination, psychosocial and cultural background, health care environment, and patient's home environment
- Analysis and nursing diagnosis: examples, risk for injury, impaired cognition, lack of knowledge, and risk for poisoning
- Planning and outcomes identification: patient participation, setting priorities, selecting priorities based on risk and patient characteristics, teamwork, and communication
- Implementation: health promotion, developmental interventions, environmental interventions, acute and restorative care
- Evaluation: through the patient's eyes, are the patient's expectations met?, patient outcomes, monitoring care by the health care team, and continually assessing needs for additional support
Nursing as a Profession
- To act professionally, a nurse must use critical thinking skills, administer quality patient-centered care, and be responsible and accountable.
- Nursing requires current knowledge and practice standards, an insightful and compassionate approach, and critical thinking and clinical judgment.
Benner's Model of Nursing Practice
- Benner's model describes the stages of nursing development, from novice to expert.
- The five stages are:
- Novice: Beginner nurse student with no nursing experience.
- Advanced Beginner: Some level of experience, maybe only observational.
- Competent: A nurse who has been in the same clinical position for 2-3 years.
- Proficient: A nurse with more than 2-3 years of experience.
- Expert: A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem.
American Nurses Association (ANA)
- The ANA is the professional organization for nurses in the United States.
- The ANA publishes standards of practice and performance for nursing, including:
- Standards of Professional Nursing Practice.
- Standards of Professional Performance.
- Code of Ethics.
Nursing Process
- Also known as the "Nursing Process," a model for clinical decision making.
- The six stages of the nursing process are:
- Assessment.
- Diagnosis.
- Outcomes Identification.
- Planning.
- Implementation.
- Evaluation.
Professional Responsibilities and Roles
- Autonomy and accountability.
- Caregiver.
- Advocate.
- Educator.
- Communicator.
- Manager.
Historical Influences
- Florence Nightingale:
- Established the first nursing philosophy (Nursing Theory) based on health maintenance and restoration.
- Organized the first program for training nurses.
- First practicing epidemiologist.
- Improved sanitation in battlefield hospitals.
- Practices remain a basic part of nursing today.
- Other historical figures, such as Clara Barton, Dorothea Dix, and Mary Mahoney, contributed to the development of nursing.
Contemporary Influences
- Quality and Safety Education for Nurses (QSEN):
- Patient-centered care.
- Teamwork and collaboration.
- Evidence-based practice.
- Quality improvement.
- Safety.
- Informatics.
Professional Registered Nurse Education
- Prelicensure education:
- 2-year associate's degree.
- 4-year bachelor's degree.
- Graduate education:
- Master's degree, advanced practice RN.
- Doctoral preparation.
- Continuing and in-service education.
Nursing Practice
- Nurse Practice Acts (NPAs):
- Regulate the scope of nursing practice.
- Protect public health, safety, and welfare.
- Licensure and certification.
- Requirements vary by state.
Health Care Delivery System
- Four challenges facing nursing:
- Aging baby boomer generation.
- Shortage and uneven distribution of physicians.
- Rate of nurses' retirements.
- Uncertainty of health care reform.
- Traditional levels of health care:
- Preventative.
- Primary.
- Secondary.
- Tertiary.
- Restorative.
- Continuing health care.
- Integrated health care delivery:
- Primary and preventive health care services.
- Secondary and tertiary care.
- Restorative care.
- Continuing care.
Health and Wellness
- Healthy People 2030:
- Provides evidence-based, 10-year national objectives for promoting health and preventing disease.
- Identifies leading health indicators which are high-priority health issues in the United States.
- Definition of Health:
- A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.
- A state of being that people define in relation to their own values, personality, and lifestyle.
- Models of Health and Illness:
- Health Belief Model.
- Health Promotion Model.
- Maslow's Hierarchy of Needs.
- Holistic Health Model.
- Variables Influencing Health and Health Beliefs and Practices:
- Internal variables.
- External variables.
Illness
- Definition of Illness:
- A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired.
- Acute illness.
- Chronic illness.
- Illness Behavior:
- Involves how people monitor their bodies and define and interpret their symptoms.
- Variables influencing illness and illness behavior.
- Impact of Illness on the Patient and Family:
- Behavioral and emotional changes.
- Impact on body image.
- Impact on self-concept.
- Impact on family roles.
- Impact on family dynamics.
Caring for Yourself
- Eat a nutritious diet.
- Get adequate sleep.
- Engage in exercise and relaxation activities.
- Establish a good work-family balance.
- Engage in regular nonwork activities.
- Develop coping skills.
- Allowing personal time for grieving.
- Focus on spiritual health.
- Find a mentor.
Legal Implications in Nursing Practice
- Legal Limits of Nursing:
- Sources of law.
- Scope and standards of nursing.
- Standards of nursing care.
- Federal Statutes Affecting Nursing Practice:
- Patient Protection and Affordable Care Act (PPACA).
- Emergency Medical Treatment and Active Labor Act.
- Health Insurance Portability and Accountability Act (HIPAA).
- Health Information Technology Act.
- Americans with Disabilities Act (ADA).
- Mental Health Parity and Addiction Equity Act.
- Patient Self-Determination Act.
- Uniform Anatomical Gift Act.
- The Omnibus Budget Reconciliation Act (1986).
- State Statutes Affecting Nursing Practice:
- Nurse practice acts.
- Health care acts and informed consent.
- Good Samaritan laws.
- Public health laws.
- Termination of pregnancy.
- Physician-assisted suicide.
- The Uniform Determination of Death Act.
- Nursing Workforce Guidelines:
- Staffing and nurse-to-patient ratios.
- Nursing assignments.
- Patient abandonment.
- Nurse delegation.
- Nursing students.
- Legal Implications and Reducing Your Legal Risks:
- Torts.
- Negligence.
- Malpractice.
- Malpractice insurance.
- Nurse experts.
- Reducing legal risks.
- Risk management and performance/quality improvement.
- Professional involvement.### The Need for Evidence-Based Practice
- Evidence-based practice (EBP) is a problem-solving approach to clinical practice that combines the best evidence with a clinician's expertise, patient preferences and values, and healthcare resources in making decisions about patient care.
- The best scientific evidence comes from well-designed, systematically conducted research studies found in scientific, peer-reviewed journals.
- Steps of evidence-based practice:
- Cultivate a spirit of inquiry
- Ask a clinical question in PICOT format
- Search for the best evidence
- Critically appraise the evidence
- Integrate the evidence
- Evaluate the outcomes of practice decision or changes
- Communicate the outcomes of the evidence-based practice decision
- Cultivating a spirit of inquiry involves constantly questioning current practices, leading to consistent use of EBP.
- Asking a clinical question in PICOT format involves identifying the patient population, intervention, comparison, outcome, and time.
- Searching for the best evidence involves using sources such as agency policy, procedure manuals, quality improvement data, existing clinical practice guidelines, and journal articles.
- Critically appraising the evidence involves synthesizing or combining the findings, considering the scientific rigor of the evidence, and determining the value, feasibility, and usefulness of the evidence.
- Integrating the evidence involves applying the research in a patient's plan of care, using evidence as rationale, and incorporating the change into policies and procedures.
- Evaluating the outcomes of practice decision or change involves determining whether the change was effective, if modifications are needed, and if the change should be discontinued.
Scientific Method
- The scientific method involves:
- Making an observation
- Asking questions and gathering information
- Analyzing the literature and forming a research question or hypothesis
- Conducting a study using scientific rigor
- Analyzing the data and drawing conclusions
- Types of research studies:
- Quantitative research: Experimental research, nonexperimental research, surveys
- Qualitative research: Inductive reasoning
Nursing Research
- Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively.
- Many professional and specialty nursing organizations support the conduct of research for advancing nursing science.
- Translation research phases:
- Preclinical and animal studies: Basic science research
- Phase 1 clinical trials: Testing safety and efficacy in a small group of human subjects
- Phase 2 and 3 clinical trials: Testing safety and efficacy in a larger group of human subjects and testing for comparison to standard treatment
- Phase 4 clinical trials and outcomes research: Translation to practice
- Phase 5 population-level outcomes research: Translation to community
- Outcomes research helps patients, healthcare providers, and those in healthcare policy make informed decisions on the basis of current evidence.
- The conduct of nursing research involves studying nursing questions and problems in greater depth within the context of nursing.
Performance Improvement
- Performance improvement (PI) is a formal approach for the analysis of healthcare-related processes.
- PI reviews how existing interventions within a process function.
- PI combined with EBP is the foundation for excellent patient care and outcomes.
- Performance improvement programs focus on processes or systems that significantly contribute to outcomes.
The Relationship Among EBP, Research, and PI
- Although EBP, research, and PI are closely related, they are separate processes.
- EBP uses information from research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes.
- Research involves systematic inquiry that answers questions, solves problems, and contributes to the generalizable knowledge base of nursing.
- QI improves local work processes to improve patient outcomes and health system efficiency; results are usually not generalizable.
Caring in Nursing Practice
- AONE Guiding Principles for Future Care Delivery
- Theoretical views on caring:
- Leininger's Transcultural Caring
- Watson's Transpersonal Caring
- Swanson's Theory of Caring
- Common themes among nursing caring theories:
- Caring is highly relational
- Caring is obvious when it is absent
- Enabling is an aspect of caring
- Knowing the context of a patient's illness helps choose and individualize interventions that will actually help the patient### Patient's Perspective of Caring
- Patients value the affective dimension of nursing care
- Caring Assessment Tool measures patients' perceptions of caring
- Patients become active partners in the plan of care when they sense healthcare providers are sensitive, sympathetic, compassionate, and interested in them as people
Ethic of Care
- Caring is an interaction of mutual respect and trust
- An ethic of care is concerned with relationships between people and a nurse's character and attitude toward others
Caring in Nursing Practice
- Caring is one of the human behaviors that can be given and received
- Recognize the importance of self-care and use caring behaviors to reach out to colleagues and care for them as well
Providing Presence
- Providing presence is a person-to-person encounter conveying a closeness and sense of caring
- Presence involves "being there" and "being with"
- Nursing presence is the connectedness between a nurse and a patient
- Establishing presence strengthens the ability to provide effective patient-centered care
Touch
- Provides comfort and creates a connection
- Types of touch: noncontact, contact, task-oriented, caring, and protective touch
- Use touch with discretion as it conveys many messages
Listening
- Necessary for meaningful interactions with patients
- True listening leads to knowing and responding to what really matters to a patient and family
- Listen effectively by silencing yourself and listening with an open mind
- Through active listening, truly know your patients and what is important to them
Knowing the Patient
- The core of clinical decision making and patient-centered care
- Two elements that facilitate knowing are continuity of care and clinical expertise
- Factors of knowing include time, continuity of care, teamwork of the nursing staff, trust, and experience
Spiritual Caring
- Spiritual health is achieved when a person can find a balance between life values, goals, and belief symptoms and those of others
- Spirituality offers a sense of intrapersonal, interpersonal, and transpersonal connectedness
Relieving Symptoms and Suffering
- Reducing symptoms and suffering requires caring nursing actions that give a patient comfort, dignity, respect, and peace
- Convey a quiet, caring presence, touch, or listen to assess and understand the meaning of a patient's discomfort
Family Care
- Caring for an individual includes their family
- Help family caregivers be active participants
- Understand the stress a patient's illness places on family members
The Challenge of Caring
- Challenges: task-oriented biomedical model, institutional demands, time constraints, reliance on technology, cost-effective strategies, and standardized work processes
- Health care must become more compassionate to make a positive difference
Scientific Knowledge Base
- Environmental safety: basic human needs, common environmental hazards, transmission of pathogens
- Factors influencing patient safety: developmental stages and risks, individual risk factors, and risks in health care agencies
Nursing Knowledge Base
- Factors influencing patient safety: developmental stages and risks, individual risk factors, and risks in health care agencies
- Risks in health care agencies: procedure-related accidents, equipment-related accidents, chemical exposure, falls, and workplace safety
Nursing Process
- Assessment: through the patient's eyes, nursing history and examination, psychosocial and cultural background, health care environment, and patient's home environment
- Analysis and nursing diagnosis: examples, risk for injury, impaired cognition, lack of knowledge, and risk for poisoning
- Planning and outcomes identification: patient participation, setting priorities, selecting priorities based on risk and patient characteristics, teamwork, and communication
- Implementation: health promotion, developmental interventions, environmental interventions, acute and restorative care
- Evaluation: through the patient's eyes, are the patient's expectations met?, patient outcomes, monitoring care by the health care team, and continually assessing needs for additional support
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Description
Explore the fundamentals of nursing as a profession, including critical thinking, patient-centered care, responsibility, and the scope of professional nursing practice.
