Study Guide RN 169.docx

[Study Guide] **Ch.1 Nursing Today** Nursing as a Profession - To act professionally, you will: - Use critical thinking skills - Administer quality patient-centered care - Be responsible and accountable - Understand the scope of professional nursing practice and how...

[Study Guide] **Ch.1 Nursing Today** Nursing as a Profession - To act professionally, you will: - Use critical thinking skills - Administer quality patient-centered care - Be responsible and accountable - Understand the scope of professional nursing practice and how nursing influences the lives of your patients, their families and their communities. Science and Art of Nursing Practice - Nursing requires: - Current knowledge and practice standards - Insightful and compassionate approach - Critical thinking and clinical judgment Benner: From Novice to Expert - Novice -- Beginner Nurse Student, no nursing experience - Advanced Beginner -- Some level of experience, maybe only observational. \*grad nurse - Competent -- A nurse who has been in the same clinical position for 2-3 years. \*is able to asses efficiently - Proficient -- A nurse with more than 2-3 years. \*experience broader different departments/units - Expert -- A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem. American Nurses Association (ANA) Nursing: Scope and Standards of Practice - Standards of Professional Nursing Practice - Standards of Professional Performance - Code of Ethics - Professional practice includes knowledge from social and behavioral sciences,biological and physiological sciences, and nursing theories. In addition, nursing practice incorporates ethical and social values, professional autonomy, and a sense of commitment and community (American Nurses Association \[ANA\] (ANA) Standards of Practice Also known as the "Nursing Process" -- a model for clinical decision making. 1. Assessment (subjective) collects data 2. Diagnosis analyzes the assessment data to determine the actual or potential diagnoses,problems, & issues 3. Outcomes Identification 4. Planning 5. Implementation 6. Evaluation progress (ANA) Standards of Professional Performance - Ethics Nurse practice ethically - Advocacy - Respectful and equitable practice - Communication - Collaboration - Leadership - Education - Scholarly Inquiry - Quality of practice - Professional practice evaluation - Resource Stewardship - Environmental Evaluation Professional Responsibilities and Roles (double check if this is needed) - Autonomy and accountability - Caregiver - Advocate - Educator - Communicator - Manager Florence Nightingale - Established first nursing philosophy (Nursing Theory) based on health maintenance and restoration -- Nightingale\'s Environmental Theory - Organized first program for training nurses - Improved sanitation in battlefield hospitals - Practices remain a basic part of nursing today Civil War to the Beginning of the Twentieth Century - Clara Barton-Founder of American Red Cross - Dorthea Lynde Dix- Organized Hospitals etc. Civil War - Mary Ann Ball (Mother Bickerdyke) --Helped Dix - Harriet Tubman-Underground Railroad Movement - Mary Mahoney\_ First Educated African American Nurse - Isabel Hampton Robb- ANA,American Journal of Nursing - Lillian Wald- Opened the , The Henry Settlement" Twentieth Century - 1990: ANA established Center for Ethics and Human Rights - 1994: University of Washington Medical Center became the first Magnet®-designated organization Quality and Safety Eduation for Nurses (QSEN) **PTEQSI** - **Patient-centered care** - Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs - **Teamwork and collaboration** - Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve high-quality patient care. - **Evidence-based practice** - Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. - **Quality improvement** - Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. - **Safety** - Minimize risk of harm to patients and providers through both system effectiveness and individual performance. - **Informatics** - Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. **Ch. 2 The Health Care Delivery System** - Preventative - Primary - Secondary - Tertiary - Restorative - Continuing health care Integrated Health Care Delivery (1 of 4) - Primary and preventive health care services - Primary health care - Focus on improved health outcomes for an entire population - Requires collaboration among health professionals, health care leaders, and community members - Health promotion programs - Designed to reduce the incidence of disease - Preventive care - Focused on reducing and controlling risk factors for disease Integrated Health Care Delivery (2 of 4) - Secondary and tertiary care - Hospitals - Intensive care - Mental health facilities - Rural hospitals - Discharge planning Integrated Health Care Delivery (3 of 4) - Restorative care - Home care - Rehabilitation - Extended care facilities Integrated Health Care Delivery (4 of 4) - Continuing care Longer care - Nursing centers or facilities - Assisted living expensive but good care - Respite care- is a service that offers short-term relief by providing a new environment or time to relax for family caregivers who support the ill, disabled, or frail older adult. Recommend respite services to the family (be sent to a nursing home) - Adult day care centers offer a variety of health and social services - Palliative and hospice care Palliative is comfort measures Some fascilities only offer palliative services in palliative care they can offer services for the disease where hospice care is also palliative Hospice is a system of fam.-centered care that allows patients to live w/ comfort, independence, and dignity while easing the pain of terminal illnesses **Ch 2** pg 26 Competency-The Quality and Safety Education for Nurses (QSEN) project developed quality and safety competencies for nurses so that they would have the knowledge, skills, and a itudes to meet the challenges in today's health care se ings LVN vs RN RN: Assessments, and clinical judgment for PTs (physical therapist, IV insertion, IV push, LVN: Cannot chart, canot maintain IV, Give meds (with the autonomy they can do that) CNA: Basic Patient care, ambulating them **Ch. 23** Nurse Delegation Nurse delegation is defined in Nurse Practice Acts; regulations vary from state to state. nurse delegation means that an RN educates, observes, and verifies that a non-nurse can do a specific task that is usually completed by a nurse (see Chapter 21) The RN retains responsibility to supervise care received by the patient and to periodically reassess whether nurse delegation continues to be appropriate **Ch 6 Health and Wellness** *Healthy People* - Provides evidence-based, 10-year national objectives for promoting health and preventing disease - *Healthy People 2030* - Promotes a society in which all people live long, healthy lives - 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 (WHO) Models of Health and Illness - Maslow's Hierarchy of Needs Figure 6.3 Maslow's hierarchy of needs. An image showing the steps of basic human needs, including self-actualization, self-esteem, love and belonging needs, safety and security, and physiological needs. Variables Influencing Health\ and Health Beliefs and Practices - Internal variables - Developmental stage - Intellectual background - Perception of functioning - Emotional factors - Spiritual factors - External variables - Family role and practices - Social determinants of health - Culture Ex. Food insecurity is external Three Levels of Prevention - Primary prevention (Ex. Vaccinations, education...) - True prevention that reduces the incidence of disease - Secondary prevention (Ex. Treatment, screening, biopsy...) - Focuses on preventing the spread of disease, illness, or infection once it occurs - Tertiary prevention (Ex. Cancer, rheumatoid arthritis...) - Occurs when a defect or disability is permanent or irreversible Risk Factors - Any attribute, quality, environmental situation, or trait that increases the vulnerability of an individual or group to an illness or accident - Risk factors include: - Nonmodifiable risk factors (age, gender, genetic) cannot be changed - Modifiable risk factors (can be changed) smoking, weight, physical activity, drinking alcohol, smoking, insufficient rest and sleep - Environment (Where we live and the condition of that area ex. Air, water and soil) Risk Factor Identification and Changing Health Behaviors - Identify risk factors - Assessment - Implement education and counseling Illness - Illness behavior - Involves how people monitor their bodies and define and interpret their symptoms - Variables influencing illness and illness behavior - Internal variables - External variables (visibility, fam. Ch. 23 Legal Implications in Nursing Practice Legal Limits of Nursing (1 of 2) - Sources of law - Constitutional law (Federal & state constitutions) Ex. The right to refuse treatment - Statutory law (Statutes passed by the U.S Congress & State legislatures) - Civil law (nurse practice acts)-Are civil State laws that define nursing and the standards nurses must meet within individual states. - Criminal law (felonies or misdemeanors) - Administrative law (regulatory law) -Civil & criminal - Common law-hippa - Case law (decisions made in legal cases) - Scope and standards of nursing (2 of 2) (ANA) - Defines nursing and reflects the values of the nursing profession - Standards of nursing care - Reflect the knowledge and skill ordinarily possessed and used by nurses Federal Statutes Affecting Nursing Practice (1 of 5) - Patient Protection and Affordable Care Act (PPACA) - Consumer rights and protections - Affordable health care coverage - Increased access to care - Quality of care that meets the needs of patients (2 of 5) - Emergency Medical Treatment and Active Labor Act - Prohibits the transfer of patients from private to public hospitals without appropriate screening and stabilization - Health Insurance Portability and Accountability Act (HIPAA) - Provides rights to patients and protects employees (only the care members can talk about the patient) (3 of 5) - Health Information Technology Act (Nurses must ensure (PHI) patients health info. Is protected like HIPPA) - Nurses must ensure PHI is protected - Americans with Disabilities Act (ADA) - Protects rights of people with physical or mental disabilities (4 of 5) - Mental Health Parity and Addiction Equity Act - Requires health insurance companies to provide coverage for mental health and substance use disorder (SUD) treatment - Patient Self-Determination Act - Requires health care institutions to provide written information to patients concerning their rights to make decisions about their care, including the right to refuse treatment and to formulate an advance directive (5 of 5) - Uniform Anatomical Gift Act - Provides the foundation for the national organ donation system State Statutes Affecting Nursing Practice (1 of 4) - Nurse practice acts - State laws intended to protect citizens, make nurses accountable and assure that care is consistent with best practice within the scope and standards of nursing (2 of 4) - Health care acts and informed consent - The patient (Key elements of informed consent) 1. Receives an explanation of the procedure 2. Receives the names and qualifications of people performing and assisting in the procedure 3. Receives a description of the serious harm, including death, that may occur and the anticipated pain and/or discomfort 4. Receives an explanation of alternative therapies and the risks of doing nothing 5. Knows that he or she has the right to refuse the procedure or treatment without discontinuing other supportive care 6. Knows that he or she may refuse the procedure or treatment even after the procedure has begun (3 of 4) - Good Samaritan laws - Limit liability and offer legal immunity if a nurse helps at the scene of an accident (youre protected in the scope of practice) - Public health laws - Laws affect individuals, populations, and communities - Are intended to improve the health of people (mandated reporter) - Termination of pregnancy - Laws vary by state - Know the law in your state related to termination of pregnancy before working in this area of practice (4 of 4) - Physician-assisted suicide - Laws vary by state - Know your state's laws and ensure that your practice falls within the laws' requirements - The Uniform Determination of Death Act - Determines actual death Nursing Workforce Guidelines - Staffing and nurse-to-patient ratios (Ratio shouldn't be more than state guideline but it can be lowered) - Nursing assignments (Once assigned a patient you can't abandon) - Patient abandonment - Nurse delegation (CNA, LPN, LVN) - Nursing students (students are liable if their actions exceed their scope of practice) Legal Implications and Reducing Your Legal Risks (2 of 5) - Negligence - Conduct that falls below the generally accepted standard of care of a reasonably prudent person - Malpractice - A type of negligence; the person being held liable for malpractice must be a professional - Standard of proof - What a reasonably prudent nurse would do under similar circumstances in the geographical area in which the alleged breach occurred (3 of 5) - Malpractice insurance - Contract between an insurance company and a nurse or employer that is intended to cover costs incurred when a patient sues the employer and/or the nurse - Nurse experts - When a case that involves nursing care is filed, a nursing expert will often testify about the standards of nursing care as applied to the facts of a case (4 of 5) - Reducing legal risks - In addition to being aware of the actions taken at the organizational level by your employer, it is important that you remain involved in the nursing profession to reduce your personal legal risk. - Risk management and performance/quality improvement - Programs help to reduce a nurse's legal risk for malpractice and negligence because they help to identify potential hazards and eliminate them before harm occurs. (Make sure you work at company that support you) (5 of 5) - Professional involvement - It is important to implement actions in your own practice that will help reduce your legal risk. - Develop and use clinical judgment to identify patient needs and make sound clinical decisions. - Remain aware of current issues in healthcare. - Become involved in professional organizations and committees that define the standards of care for nursing practice.