Fundamentals review test part 2

Nursing Theories and Frameworks

• Virginia Henderson (1955): Goal is to help patients achieve independence in meeting their needs quickly. Framework focuses on fourteen fundamental needs.
• Dorothy Johnson (1968): Goal is to reduce stress, fostering quick recovery. Framework uses seven behavior subsystems in an adaptation model.
• Martha Rogers (1970): Goal is to maximize wellness. Framework uses the concept of "unitary man" evolving throughout life.
• Dorthea Orem (1971): Goal is to care for and support patients with self-care needs. Framework identifies self-care deficits.
• Betty Neuman (1972): Goal is to help individuals, families, and groups attain and maintain maximum wellness via purposeful interventions. Framework uses a systems model, reducing stress via primary, secondary, and tertiary prevention.
• Sister Callista Roy (1976): Goal is to identify and assist with patient adaptation to demands. Framework focuses on four adaptive modes: physiologic, psychologic, sociologic, and independence.
• Jean Watson (1979): Goal is to promote health, restore patients, and prevent illness. Framework uses "carative" factors with caring as an interpersonal process.
• Rosemarie Parse (1987): Goal is to assist patient interaction with the environment, co-creating health and sustaining a safe environment.
• Patricia Benner and Judith Wrubel (1989): Goal is to care about the patient as an individual; caring is central.

Healthcare System Levels

• Preventative: Education, prevention
• Primary Care: Early detection, routine care
• Secondary Care (acute): Early treatment, critical care (intense, comprehensive diagnosis and treatment)
• Tertiary Care: Special care (highly technical services for clients in large geographic areas)
• Restorative Care: Intermediate follow-up (surgical post-operative, routine care, routine medical care), rehabilitation, home care
• Continuing Care: Long-term care, chronic care, personal care, hospice care

Healthcare Services

• Preventative and Primary Care includes health promotion, prenatal care, well-baby care, nutrition counseling, exercise classes, family planning, meditation classes, emergency preparedness, fire prevention, mature driver classes, smoking cessation, school physicals, illness prevention, immunizations, blood pressure screening, health fairs, mental health counseling/crisis intervention, child safety classes, annual physical checkups, and vision screenings.
• Secondary Care (acute): Includes radiologic procedures, lab & diagnostic procedures, surgical procedures, inpatient services, restorative care, rehabilitation services, emergency care, physical therapy, speech therapy, occupational therapy, home health care, and cardiovascular/pulmonary outpatient rehabilitation.
• Tertiary Care (restorative & continuing): Extended (long-term) care, chronic disease management, assisted living care, medical homes, in-home personal care, hospice care, and palliative home care.

Definitions

• Acute Illness: Develops suddenly, resolves quickly
• Adaptation: Adjustment in the structure of habits
• Asymptomatic: Without symptoms
• Autonomic: Not subject to voluntary control
• Chronic Illness: Persists long-term
• Complementary Health: Acupuncture, acupressure, biofeedback, meditation
• Congenital: Present at birth
• Convalescence: Recovery after illness, regaining strength
• Defense Mechanism: Strategies protecting from anxiety
• Disease: Pathological process causing illness
• Etiology: Cause
• Health: State of optimal physical, mental, and social well-being
• Health Literacy: Knowledge & skills for health care decisions
• Hierarchy: Arrangement of objects, elements, or values
• Holistic: Considering biological, psychological, sociological, and spiritual aspects and needs
• Homeostasis: Biological systems maintain a stable internal environment by continuously adjusting to needed changes for survival.
• Idiopathic: Illness with unknown cause
• Illness: Disease of mind and body
• Maladaptation: Lack of adjustment
• Primary Illness: Develops without cause from another problem.
• Secondary Illness: Results from or is caused by a primary illness.
• Self-actualization: Reaching one's full potential
• Stress: Biologic reaction to adverse stimulus
• Stressor: Adverse stimulus
• Subjective: Perceived only by the individual
• Terminal Illness: No cure available
• Wellness: Physical and mental well-being

Healthy People 2030

• Overarching Goals: Attain healthy, thriving lives and well-being free from preventable disease, disability, injury, and premature death. Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. Create social, physical, and economic environments that promote the full potential for health and well-being of all. Promote healthy development, healthy behaviors, and well-being across all life stages. Engage in leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being for all.

Common Stressors in Healthcare

• Ill-fitting gowns, roommate sharing with strangers, toileting/bathing dependency, altered mealtimes, multiple awakenings, visitor restrictions, medical costs/bills/family needs, uncertain diagnoses/outcomes, unfamiliar medical terms, multiple strangers as healthcare workers, inability to obtain desired items, improper use of warm covers, waiting/delays for procedures/providers, repeated needle use, interruptions during care, differing personnel providing care each day.

Defense Mechanisms

• Repression: Unconsciously blocking a wish/desire from conscious awareness. (e.g., forgetting someone's name due to negative feelings)
• Denial: Refusing to acknowledge unpleasant thoughts/situations. (e.g., a widowed woman speaking of her late husband in the present tense.)
• Projection: Blaming/scapegoating others for unconscious feelings/impulses. (e.g., a man unaware of his attraction to a friend's wife accusing his own wife of flirting with the friend.)
• Reaction-formation: Intense feeling about an object, person, or feeling out of awareness is unknowingly acted out consciously in an opposite manner. (e.g., treating someone you dislike intensely in an over-friendly manner)
• Regression: Returning to an earlier, less mature stage of behavior. (e.g., a child resumes bedwetting after long periods of being toilet trained following the arrival of a sibling.)
• Rationalization: Unconsciously falsifying an experience by giving contrived, socially acceptable, and logical explanations to justify unpleasant experiences/questionable behaviors. (e.g., blaming an exam failure on the teacher's poor lecture material or unfair tests instead of taking responsibility.)
• Identification: Modeling behavior after someone else. (e.g., a young girl dressing in her mother's clothing.)
• Displacement: Discharging intense feelings for one person onto a less threatening object. (e.g., a child hitting a doll after being scolded by a parent).
• Sublimation: Rechanneling an impulse into a more socially desirable object. (e.g., satisfying sexual curiosity through research into sexual behavior.)

Legal Terms (Expanded)

• Advanced directives: Written patient statements specifying future treatment preferences.
• Appeal: Challenging a court decision, a higher court reviewing for affirmation or reversal.
• Civil rights/Civil law: Individual rights, liberties, constitutionally guaranteed.
• Competent: Mentally and emotionally capable to understand and to act.
• Controlled substances: Drugs regulated due to abuse potential (narcotics, tranquilizers, stimulants).
• Crime: Violation of law.
• Damages: Monetary compensation to an injured party (plaintiff) for negligence by the defendant.
• Defendant: Accused in a civil or criminal action.
• Emancipated minor: Under 18 years with legal adult status (marriage, parenthood).
• Felony: Serious crime often resulting in imprisonment beyond one year.
• Healthcare agent: Person designated by patient to make decisions (advanced directive).
• Liability: Responsibility for losses or injuries resulting from negligence.
• Litigation: Lawsuit, legal process resolving disputes.
• Malpractice: Professional harm caused by failing to meet professional standards.
• Malpractice insurance: Protects against malpractice costs.
• Medical Power of Attorney: Legal assessment for others' health care decisions.
• Misdemeanor: Less serious crime often leading to fines, a year or less incarceration.
• Negligence: Departure from expected, reasonable professional care standards.
• Plaintiff: Party alleging injury/harm and seeking legal remedy.
• Power of attorney: Legal act permitting someone else to conduct business.
• Precedent: Legal decision serving as guide for similar cases.
• Privileged relationship: Requires confidentiality due to trust in the relationship.
• Statute: Law.
• Tort: Violation of civil law, a wrong against an individual.

Nurse Responsibilities/Delegation

• 5 Rights of Delegation: Right task, circumstance, person, supervision, and direction.

Patient Care Partnership

• Hospital Stay Expectations: High-quality, safe, clean care; involvement in decisions; privacy protection; discharge preparation assistance; bill/claim assistance.

2020 Hospital National Patient Safety Goals

• Patient Identification/Blood Transfusions: Using at least two patient identifiers, ensuring correct blood transfusions.
• Staff Communication: Timely, accurate test result delivery.
• Medication Safety: Proper labeling, extra care for blood thinners, accurate recording, and communication of medications.
• Alarm Safety: Effective, timely response to alarms.
• Infection Prevention: Following CDC/WHO hand hygiene protocols; preventing infections from central lines, surgeries, and urinary tract infections.
• Patient Safety Risk: Suicide prevention.
• Surgical Errors: Confirming correct patient, surgery, and site; pausing if errors suspected.

Elements of Malpractice

• Duty: Obligation to apply due care.
• Breach of Duty: Failure to meet the due care standard.
• Causation: Actions/inactions causing harm.
• Injury/Damages: Physical, emotional, or financial harm.

Guidelines to Reduce Legal Risk

• Maintain Competence: Staying current with skills, facility/state policies, continuing education, and identifying areas for improvement.
• Document Fully: Accurate, thorough, factual documentation is crucial.
• Establish Rapport: Building relationships, actively listening to patient needs and concerns, addressing them respectfully with preferred names.
• Communicate Effectively: Employing therapeutic communication. Notify supervisors about patient/family concerns.
• Take Care of Yourself: Prioritizing self-care to prevent errors due to fatigue, burnout, or sleep deprivation.

Ethical Terms in Nursing

• Beneficence: Doing good.
• Nonmaleficence: Avoiding harm.
• Veracity: Honesty.
• Fidelity: Keeping promises.
• Autonomy: Respecting self-determination.
• Justice: Treating with fairness and respect.

NAPNES Code of Ethics & NALPN Code (LPN/Vocational Nurses)

• Detailed codes of ethics for nurses and licensed practical/vocational nurses regarding conduct, patient care, confidentiality, and ethical obligations.