NSC 252 Final Study Guide PDF

Nursing History Pre-1800s o Influenced by social, political, economic factors o Desperate people cared for desperate people o Guards drugged “rowdy” pt at night Early-Mid 1800s o Florence nightingale: 1st nurse to look @ research; @ 30 enter...

Nursing History Pre-1800s o Influenced by social, political, economic factors o Desperate people cared for desperate people o Guards drugged “rowdy” pt at night Early-Mid 1800s o Florence nightingale: 1st nurse to look @ research; @ 30 entered a 3-year nursing program in Germany, teachings of cleanliness were basic but profound o Crimean War: many deaths from injuries and disease: Nightingale went to work o 1860: St Thomas’s Hospital in London founded, model for nurse training in US o Hospitals treated as communes Mid-late 1800s o Civil War: death rate skyrocketed. Govt. asked Nightingale for help. Began to plan hospitals and recruit nurses o Physicians protested nurses but became desperate o 1881: Clara Barton formed American Red Cross o 1886: School for male nurses @ NYC training school founded o Training hospitals based teaching on hospital needs, no standardization Late 1800s o Diploma nurse training/ apprenticeships: medical model, physician led o Segregation o 1893: Chicagos world fair: NLN founded by superintendents, start of formal nursing o 1896: ANA beginnings founded o Laws raised nursing standards and enhanced collaboration btw nurses and educators o Nursing students exploited for free work w/ poor conditions Early 1900s o Nursing transitioned from student labor to trained nurses o 1901: 1st BSN program established o 1925: FNS founded by Mary Breckinridge and public health nursing movement o 1930s: 7000 hospitals in US, WE’RE EMPLOYEES o 1900: first issue of American Journal of Nursing was published WAR o WWI: 20k volunteer nurses, Discrimination, no rank or pay o WWI: Nurses receive officer status, rank, and pay. Became recognized for abilities and care provided Mid-late 1900s o LPN/LVN programs created to quickly train nurses for WWII o ASN education established to train nurses quicker o 1950s: required licensure exam o Aspects of society became more collaborative o 1952: NLN began voluntary accreditation. 1st nursing research published 2000s-today o 19 different professions o Increased recognition of nursing as a profession and academic discipline  o Aging of America o More men in nursing o Lifestyle changes o Advancements in nursing o Greater emphasis on health promoting o Preventative care o EBP, outcomes and economics Nursing as a profession BSN Handbook: “nursing is an independent, self-governing, and caring profession. Nursing is an art and science that promotes health through pt-centered care. While respecting pt right to self- determination, nursing provides holistic care during health, illness, and death” ANA 2014c: “nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” Altruism, excellence, caring, ethics, respect, communication, accountability, self-care, competence, leadership, ethical/legal practice, collaboration, critical thinking Roles of a nurse: caregiver, communicator, teacher/counselor, pt advocate, change agent, leader, manager, case manager Characteristics of a profession: specialized education, body of knowledge, service orientation, ongoing research, code of ethics, autonomy, professional organization Roles of a professional BSN nurse: caregiver, communicator, manager of care, leader, consultant, consumer of research, counselor, advocate Benner’s Stages of proficiency in the development as a professional nurse o Stage I- novice: no professional experience o Stage II- advanced beginner recognizes meaningful aspects of real situation o Stage III- competent: 2-3yr experience, can recognize the important, coordinates complex care plans o Stage IV- proficient: 3-5yr experience, perceives situations as whole- o Stage V- expert: performance is highly proficient Social Policy Statement: establishes a framework for understanding professional nursing’s relationship w/ society and nursing’s obligations to those who receive nursing care Scope and standards of practice: outlines what we can and should do as nurses Code of ethics: ethical values and obligations, protects us if we follow APA Format 1 in margins on each side, 12 pt font, times new roman, double spaced, indent each paragraph (except in abstract), page number in right hand corner Consists of title page, abstract, main body, references Education levels LPN/LVN: technical prepared nurse, most work is tech skills, works under RN or MD ADN: technical registered nurse, RN, less theory based, hands on learning  BSN: professional prepared nurse, hands on learning, theory, research, EBP MSN: Advanced practical roles, nurse administrator, nurse educator as faculty in hospital, NP, clinical nurse expert, consultant, strong theory and research based, beginning researcher DNP: doctoral for practice, research utilization of EBP in practice setting PhD: doctoral for research, conducts original research Leadership Autocratic: authoritarian, ineffective in healthcare but good in code blue, members dissatisfied Democratic: discussion oriented, high group satisfaction, effective in healthcare, not in code blue Laissez-faire: hands off, lazy. Members act independently with opposing goals due to no coordination, will not work if professional maturity is missing Transactional: reward system, self-determination for growth is not there Transformation: inspires others, instills other, weakness is personality based Nursing leaders Florence Nightingale (1820-1910): founder of modern nursing, and 1st English training school Clara Barton (1841-1930): Angel of the battlefield, American red cross in 1881, schoolteacher who volunteered as nurse in the Civil War Linda Richards (1841-1930): America’s 1st trained nurse, introduced nurse’s and dr’s notes, psychiatric and industrial nursing Mary Mahoney (1845-1926): 1st African American professionally educated nurse, worked to promote equal opportunity for African American nurses Lillian Wald (1867-1940): founder of public health and henry street settlement and visiting nurse service Mary Breckinridge (1881-1965): Establish frontier nursing school in 1925, midwifery, horseback, and poverty stricken Nurse Organizations ANA: represents all US RNs. State level is KNA. Has nursing: scopes and standards of practice KBN: regulates practice and protects public. Licensure, state regulatory board NLN: promotes excellence in nursing education, school accreditation American Association of Colleges in Nursing: voice for students, implements quality standards for nursing education, voluntary accreditation National Student Nurses Association: mentors students, can be national, state or local level Informatics Education, practice, patients, management Nursing Knowlege- most abstract to concrete Nursing Metaparadigm o Consists of person, nursing, environment, health Philosophy o Set of beliefs about how the world works, puts together some or all part of metaparadigm  o Statements of beliefs about nursing and expressions of values that are used for bases for thinking and acting o Nightingale’s What needs to be adjusted in this environment to protect this pt? No grossness Nursing metaparadigm: relationship of nurse to pt is focus on restoring health by addressing impacts of environment Health of pt is related to environment Nurse’s role in protecting pt includes preventing all harm, primary nursing (continuity of care over 24hr), pet therapy o Henderson’s - Florence Nightingale of 20th century What can I help this pt do that he would do for himself if he could? Help yourself Defined profession as the unique function of the nurse to assist the pt in being able to live unaided as long as possible Nurse is help pt meet 14 basic needs (mental and physical) o Watson’s How can I create an environment of trust, understanding and openness so that the pt and I can work together in meeting their needs? Caring using a human-to-human relationship We're nurses bc we care for the welfare of others and build trusting relationships Health= harmony of mind, body, and soul 10 caritas: focuses on spiritual health Conceptual model o Organization structure that makes clearer connections btw concepts o Models are less abstract that the philosophies o Orem’s self-care model: determine the pt’s ability to provide effective self-care What deficits does this pt have in providing their own self-care? Diagnostic operation: define pt’s baseline ability, what can this pt do for themselves Prescriptive operation: what ways can we address self-care deficits, pt and nurse brainstorm to identify ways to address self-care deficits Regulatory operation: nurse designs a plan for care What are the self-care deficits, how do we address them, let’s make a plan o Roy’s adaptation model How can I modify the pt’s environment to facilitate their adaptation When the environment is too demanding for the pt their behavioral responses are ineffective for coping Effective adaptive responses: promoting integrity of individual and conserving energy and promoting human system How does the nurse change the environment to promote pt adaptation Theory o A group of related concepts, definitions, and statements that describe a phenomenon  o Represents tentative, abstract ideas rather than supported facts o Types Grand: complex and broad concepts of nursing phenomena; philosophies Middle Range: narrow focus, more concrete idea, makes connections btw grand theories and practice Practice level: focuses on specific outcomes o Purpose is to describe, explain, predict, and control outcomes o Leininger’s theory of culture care diversity What are the best ways to provide care for my client that are culturally congruent? Enabling decisions that fit with the person’s cultural values, beliefs, and lifeways Transcultural nursing o Peplau's theory of interpersonal relations in nursing Within the relationship w/ my pt, how can I best help them or understand their health problems and new, healthier behaviors? The goal is on the relationship btw the nurse and the pt Goals: survival of the pt, the pt understand the health and behavior changes they are experiencing Nurse is a counselor, resource, teacher, and leader The nurse and pt maintain a therapeutic relationship There's a continuous change in what care the pt needs o Orlando’s Nursing Process theory How can I best figure out what my pt needs through my interaction with them? How nurses process observations of pt behavior and how they react to pt based on inference of their behavior, including what they say The goal of the nurse is to determine and meet the pt needs and to improve their situation by relieving stress or discomfort Deliberate action to provide pt-specific care by observing, listening, and confirming observation o Goals for understanding theory Theory-based education Theory-based practice Theory-based research Health care delivery model Primary Prevention: keeping people from getting sick Secondary Prevention: diagnosis and treatment of illness Tertiary prevention: help pt return to baseline Factors affecting healthcare delivery: increasing number of older adults, advances in technology, economics, women’s health, uneven distribution of services, access to health care/ insurance, homeless and poor Economics  o Increased costs due to outdated equipment, changes in EBP, inflation, increasing population, increasing awareness about right to care, and increasing costs of prescriptive care o Adults >85yr account for 13% of population but 34% of total spending o Average American sees dr 3x/year o Relatively poor healthcare despite costs National Academy of Medicine (NAM) o Mission: improve health for all o Vision: a healthier future for all o 1999 publish to Err is Human: Building a Safer Healthcare System: drew attention to amt of Americans dying due to medical error o 2001 publish Crossing the Quality Chasm: A New Health System for the 21st Century; care should be: ▪ Safe: avoid injuries to pt ▪ Timely: reduce waits and harmful delays ▪ Effective: provide appropriate level of care based on scientific knowledge ▪ Efficient: avoid waste ▪ Equitable: care shouldn’t vary in quality bc of personal characteristics ▪ Pt-centered: provide care that is respectful to individual pt Major challenge is lack of accessibility and affordability American Nurses’ Association (ANA) o Focus on broad healthcare reform o Reflects aims of NAM o 2008 Agenda: elements of healthcare reform ▪ Access to healthcare: affordable, available, acceptable ▪ Quality of healthcare: safe and quality ▪ Cost of healthcare: balance btw high tech and community-based preventive services ▪ Healthcare force: adequate supply, well-educated, well-distribute, well-utilized RNs USDHHS: healthy people 2030 o Focus: health promotion and disease prevention o 5 overarching goals ▪ Attain healthy thriving lives and well-being ▪ Eliminate health disparities ▪ Create environments that promote full potential for wellbeing of all ▪ Promote healthy behaviors and well-being across all life stages ▪ Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the well-being of all The joint commission o Accrediting agency for healthcare organizations in the US o Mission: to continuously improve healthcare for the public o Develops National patient safety; to help healthcare organization measure, assess, and improve performance Nursing Leading Change  o Nurses should practice to full extent of their education and training o Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic continuation o Nurses and other healthcare professionals should be full partners in redesigning healthcare o Effective workforce planning and policy making require better data collection and improves information structure Nursing roles in healthcare reform: provider of care, educator, advocate, researcher Epidemiology: health promotion and disease prevention among populations o Triad model of epidemiological triangle: host, agent, environment o Disease is produced by exposure of susceptible host to a noxious agent in the presence of environmental factors that aid or hinder agent of disease Law and Ethics Law: created by people and exists to regulate all persons o Constitutional Law: established by the constitution o Statutory (Legislative): laws enacted by legislation. Governs nursing practice. Scope of practice ▪ Nurse practice acts, good Samaritan acts, child and abuse laws, living wills, American with disabilities act ▪ State nursing practice acts Each state defines the standards and scopes of practice Controls licensing requirements and renewal process KBN: disciplinary actions o Administrative laws: administrative agencies create rules for statutory law: KBN, homeland security, FDA o Common law: from court decisions Criminal law: actions against the safety and welfare of the public o Active euthanasia; sexual assault, illegal possession of controlled drugs Tort law: important to nursing, enforces duties and rights o Unintentional torts- unintentional errors ▪ Negligence: misconduct below expected standard ▪ Gross Negligence: extreme lack of knowledge; coming in under the influence ▪ Malpractice: professional negligence; illegal care given by licensed professional Factors that impact standard of care o Internal: job description, education, expertise, institutional policies and procedures o External: nurse practice acts, professional organizations, federal guidelines Nursing act: legal obligations o Protection of pt rights: informed consent, HIPPA o Pt Safety: delegation, mandated reporters of abuse, scopes and standards of practice o Informed consent ▪ Essential elements: disclosure, comprehension, competence, autonomy ▪ Exceptions: minors, adults with a guardian, those unable to consent, those with mental illness declared incompetent  ▪ Nurse’s role: advocate for client by confirming Voluntary consent Signature is authentic Client appears competent to consent Delegation: taking an assignment and giving it to another person that is beyond their traditional role o Must have additional knowledge, training and validated competence if needs o The nurse’s ability to assign or delegate is based on state laws and regulations o Nurse must know their own and the assistant's scope of practice o 5 rights of delegation: task, circumstances, person, directions and communication, supervision and evaluation Legal aspects of nursing o American with disabilities act: clear and comprehensive national mandates for elimination discrimination against individuals with hearing disabilities o Controlled substances: substance abuse disorder in nursing o Sexual harassment o Abortion o Death and related issues Legal protection for nurses o Good Samaritan o Professional liability insurance o Carrying out a physician's order: seek clarification from provider o Providing competent nursing care o Documentation o Incident o Report Ethic o Inquiry to understand the morality of human behavior... the practices of beliefs of a group o Morality: standards of rights and wrongs o Values: enduring attitudes about the worth of an individual, object, idea, or action ▪ Influences decisions and actions o Beliefs: opinions, interpretations or conclusions that people accept as true ▪ May only be temporary, viewed as correct or incorrect o Attitudes: mental positions or feelings toward an individual, object, or idea ▪ Lasts over time, bad/good or positive/negative Essential nursing values o Altruism o Autonomy o Human dignity o Integrity o Social justice Moral Principles o Autonomy o Nonmaleficence o Beneficence  o Justice o Fidelity o Veracity ANA code of ethics o Accountability: decisions and actions are measured against a standard o Responsibility: the praiseworthiness one bears for their conduct Nursing code of ethics: purposes o Inform public about minimum standards of profession and help them understand professional nursing conduct o Provide a sign of the profession’s commitment to the public it serves o Outline the major ethical considerations of the profession o Provide ethical standard for professional behavior o Guide the profession in self-regulation o Remind nurses of the special responsibility they assume Ethical issues in nursing o AIDS o Abortions o Organ and tissue transplant o Withdrawing/withholding foods and fluids o Termination of life-sustaining treatment o Euthanasia and assisted suicide Nurses’ obligation in ethical decision making o Maximize pts wellbeing o Balance pts need for autonomy with family members’ responsibility for pt well-being o Support each family member and enhance the family support system o Carry out hospital policies o Protect other pt’s wellbeing o Protect the nurse’s own standards of care Ethical decision making o Clarify ethical dilemma (assess) o Gather additional data (assess) o Identify options (analyze) o Make a decision (plan) o Act (implement) o Evaluate Tips for success o Know your scope of practice o Abide by rules of you governing body (KBN) o Know the standards and policies at your agency o If you don’t know, ask the right person o Stay off social media o Be aware of your own values and beliefs o Promote cultural sensitivity o Advocate for your clients Evidence Based practice and research Ways of acquiring knowledge o Tradition o Authority o Borrowing o Trial and error o Personal experience o Role-modeling o Intuition o Reasoning o Nursing research What impacts decision making: knowledge, theories, opinions of recognized experts, clinical expertise and experiences, findings during client assessments, research Reseach: using formal systematic processes to solve problems and answer questions Nursing research: systematic investigation of phenomenon related to improving nursing care o Validates and refines existing nursing knowledge o Generates new nursing knowledge Types of research o Quantitative: numerical data; objective, empirical, conclusive, controlled, tested ▪ Used for natural sciences ▪ Requires standardized experimental design, hypotheses, measurable variables and outcomes, and statistical analysis ▪ Steps: describe, explain, predict, control ▪ Subjectively and bias are minimized ▪ Types Descriptive Correlation: looking at relationship btw 2 variables Quasi-experimental: evaluates results of intervention Experimental: follows scientific method o Qualitative: systematic collection and thematic analysis of narrative variable ▪ No variables being manipulated; qualities of human experiences looked at ▪ Subjective, exploratory, discovery, naturalistic, generated ▪ Used in social sciences ▪ Human responses to health and illness ▪ Narrative and participant interviews ▪ Types Phenomenological Grounded theory Ethnographic: examining people in their own environment Explanatory-descriptive: interviewing participants ▪ Research methods: one-on-one interview, focus groups, ethnographic research, case studies, record keeping, process of observation o Mixed methods research ▪ Combination of quantitative and qualitative methodologies  ▪ Examining phenomena of interest using a variety of data collection techniques and analysis Limitations of strict definition of scientific method in nursing o Healthcare settings are not comparable to labs o Human beings are far more than collections of parts to be examined o To clarify for objectivity Steps in the research process for nursing o Identification of a researchable problem o Review of literature o Formulation of the research questions or hypotheses o Design of the study o Implementation of the study, data collection and analysis o Drawing conclusions based on findings o Discussion and clinical implications o Dissemination of findings Nursing research goals o Use research findings to improve pt care in their day-to-day practices o EBP PICOT: framework for identifying applicable research o Population of interest o Intervention o Comparison o Outcome o Time Advancing the profession through the use of research o Read and evaluate research for use in supporting their EBP o Identify nursing problem that needs to be investigated o Participate in the implementation of scientific studies o Help disseminate research-based knowledge by sharing finding with colleagues Nursing Process Done with each pt. A systematic, rational method of planning and providing individualized nursing care Phases of the nursing process- ADPIE o Assessing: collecting, organizing, validating, and documenting client data ▪ Subjective data: subject says ▪ Objective data: observed data ▪ Data collection: interview, be aware of language and bias, validate data ▪ Cannot be delegated o Diagnosing: analyzing and synthesizing data ▪ ___related to___ as evidenced by____ ▪ NANDA nursing diagnosis comes from a preestablished list o Planning: determine how to fix the problem identified in pt ▪ Develop an individualized care plan that specifies pt goals or desired outcomes with nursing interventions  Set priorities and goals in collaboration with pt Write goals and establish outcomes Select nursing strategies and interventions Consult and communicate with relevant healthcare professional Write nursing interventions and nursing care plans ▪ Types of planning: initial, ongoing, discharge ▪ Goals/outcomes SMART goals Short term Longterm Nursing outcome classification (NOC): describing pt outcomes that respond to nursing interventions o Implementing: action phase ▪ Reassess the pt to update documentation, perform planned nursing interventions, document response to nursing interventions ▪ Nursing interventions classification (NIC): broad level interventions provided but nurse should use these ideas to make them pt specific ▪ Can be delegate, must document o Evaluating: measuring the degree in which goals have been achieved ▪ Determine whether to continue, modify, or terminate care plan ▪ 3 responses to evaluating: goal was met, partially met, or not met Reflection: 5 questions o Was the care provided in a timely manner? o Was the pt assessed accurately? o Were the interventions appropriate? o Were the goals reached? o Was the nursing diagnosis resolved? Linking the Nursing Process and Critical thinking Critical thinking: process of intentional higher-level thinking to define a pt’s problem, examine the EBP in care for the pt, and make choices in care delivery Types of statements o Facts o Inferences o Judgement o Opinions Techniques to ensure effective problem solving and decision-making o Critical analysis: applying a set of questions to a situation to determine essential info o Socratic: look beneath the surface, recognized and examine assumptions, search for inconsistencies, examine multiple POVs, and differentiate what you know vs what you believe o Induction reasoning: generalizations that bc something is true many times it is all the time o Deductive reasoning: known facts to conclusions Applying critical thinking to nursing practice  o Nursing Process ▪ Problem-solving strategies: trial and error, intuition, clinical judgement, research process Attitudes that foster critical thinking o Independence, fair-mindedness, insight to egocentricity, intellectual humility, intellectual courage to challenge status quo, integrity, perseverance, confidence, curiosity Clinical reasoning o Use strategies to gather and analyze pt info, evaluate relevance of info, and decide possible nursing actions to improve pt’s outcomes o Cognitive process: thinking processes based on the knowledge of aspects of pt care o Metacognitive process: reflective thinking on pt status and determining most effective care plan o Components: setting priorities, developing rationales, learning how to act, clinical reasoning-in-transition, responding to changes in pt condition o Reflection Integrating critical thinking and reasoning: make decisions about pt care> prioritize each pt care plus care of all pt>identify changed early and act appropriately> help pt make decisions> be aware of cultural and religious beliefs> evidence-based plan of care