Intro Final Exam Review PDF

QUIZ 1 -flexner’s model: highlights the importance of professionalization in nursing, emphasizing the need for evidence-based practice, formal education, and ethical standards -high responsibility and accountability -advanced body of knowledge grounded in research -combine...

QUIZ 1 -flexner’s model: highlights the importance of professionalization in nursing, emphasizing the need for evidence-based practice, formal education, and ethical standards -high responsibility and accountability -advanced body of knowledge grounded in research -combines theoretical understanding with practical application -requires specialized education and training -motivated by altruism and public service -profession maintains a strong internal organization -benner’s stages of nursing proficiency: focuses on the development of clinical experience and the transition of nurses through different stages of skill acquisition -novice: has limited background and limited practical skills; relies on rules and expectations of other for direction -advanced beginner: has marginally competent skills; uses theory and principles much if the time; experiences difficulty establishing priorities -competent practitioner: feels component, organized, plans and sets goals, thinks abstractly and analytically, coordinates several tasks simultaneously -proficient practitioner: views patients holistically, recognizes subtle changes, sets priorities with ease, focuses on long term goals -expert practitioner: performs fluidly, grasps patient needs automatically, responses are integrated, expertise comes naturally -cohen’s model of basic student socialization: sequence that allows for students to feel comfortable in the professional role -unilateral dependance: reliant on external authority; limited questioning or critical analysis -negativity/independence: cognitive rebellion; diminished reliance on external authority -dependence/mutuality: reasoned appraisal; begins integration of facts and opinions after objective testing -interdependence: collaborative decision making; commitment to professional role; self concept now includes professional role identity -professional socialization: how to become socialized through experience -formal: students implement knowledge and skills in planned educational experiences -informal: unplanned; lessons and observation learned throughout the job -profession: “a calling, vocation, or form of employment that provides a needed service to society and possesses characteristics of expertise autonomy, long academic preparation, commitment, and responsibility” -values, beliefs, and ethics are integral -decisions based on science or theoretical constructs (evidence-based practice) -occupation: “one’s job or profession” -values, beliefs and ethics are not prominent -decisions guided by experience or trial and error -barriers to a professionalism: varying educational levels, gender issues, historical influences, external conflicts, internal conflicts, nursing image (effects of social media) -higher degree does not indicate a person is better however an increasing number of employers are requiring a BSN as minimum education -Kelly’s characteristics of the nursing profession  -accountability: individual responsibility -autonomy: practitioners are relatively independent and control their own policies and activities -altruism: practitioners are motivated by service and consider their work an important component of their lives -association: ANA organization that encourages and supports high standard of practice -miller’s wheel of professionalism in nursing education with the use of evidence-based practice: adherence to code of ethics, theory, community service orientation, CE, research, autonomy, professional participation, publication/communication -florence nightingale: nursing is a respected occupation requiring advanced education; opened a school of nursing in Lonson and pushed the initiative of training programs referred to as diploma programs (was to staff the hospitals that operated them) -before late 1800’s nursing care was administered by either the patient’s relatives, individuals affiliated with religious/military nursing orders, or self-trained persons who were often held in low regard by society -educational paths to becoming an RN -diploma programs: were earliest form of nursing education in the US -associate degree ADN: 2 year program typically used a stepping stone for a BSN -bachelor degree BSN: 4 year program advocated to be the minimum education level for professional practice -external degree: programs that allow basic nursing education without students attending class -articulated programs: build up programs that allow for credits to be easily transferred -alternative paths in nursing education: RN to BSN, accelerated BSN, second degree program, and distance/online learning -advanced degree programs: masters and doctorate (e.g. academia nursing or NP) -licensure: established and regulated at state level; student must graduate from a state-approved nursing education program to be admitted to licensure examination -certification: validates a high level of knowledge and proficiency in a particular practice area; comprehensive examination, documentation of experience, letters of reference and other documents are required -nursing education programs are accredited by the ACEN -clinical ladder: multiple step program that begins with entry level staff positions; as nurses gain experience, participate in CE, demonstrate clinical competence, pursue formal education, and become certified they are eligible to move up -delegation to UAP = data gathering duties, vital signs, intake/output, ADLs -change of shift report using SBAR = situation, background, assessment, recommendation -translational research: takes findings from lab and develops them for use at bedside then takes findings for clinical research done at bedside to ask new questions and direct new research -quantitative: numbers taken from objective data (e.g. lab findings and vitals) -qualitative: personal experiences gathered from subjective data (e.g. client states pain is 5/10) -mixed methods: numbers + interviews with clients -scientific method: examine complex human phenomena; in healthcare we look at clients as a whole while lab settings only look at one things at a time -evidence-based practice: an approach to the delivery of healthcare that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values -critical thinking: mode of thinking in which the thinker improves the quality of his or her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them -examples of ways a nurse uses reflective thinking -what assumptions have I made about this patient? -how do I know my assumptions are accurate? -do I need any additional information? -how might I look at this situation differently? -nursing is an art of applying scientific principles in a humanitarian way to care for people -the nursing process (ADPIE) serves as the organizational framework for the practice of nursing -assessment: collecting data, subjective and objective -diagnosis (NANDA): analyzing data to determine actual or potential health problems, prioritizing with Maslow’s -planning: developing personalized outcomes and SMART goals -implementation: carrying out interventions that help meet SMART goals -evaluation: evaluating outcomes of the interventions, determining if SMART goals were met Quiz 2 ○ Theorists Florence Nightingale: Nightingale’s Environmental Theory - A patient’s health is related to their environment 10 major concepts: ventilation and warming, light and noise, cleanliness of the area, health of houses, bed and bedding, personal cleanliness, variety, food, offering hope and advice, and observation Virginia Henderson: Needs Theory - The nurse should focus nursing care on the patient’s needs 14 needs identified: breathing, eating, elimination, movement, sleep and rest, clothing, body temperature, hygiene, environmental control, communication, religious practice, work, leisure and learning Jean Watson: Theory of Human Caring- the nurse and the patient can change together through a relationship focused on caring Ten Carative Factor: Sustaining humanistic-altruistic values by practice of loving-kindness; enabling faith/hope/ belief system; being sensitive to self and others by cultivating own spiritual  practices; trusting-caring relationships; allowing for expression of positive and negative feelings; Caring-healing relationships at all levels (body, mind, and spirit); teaching and learning within context of caring relationship; creating a healing environment; basic needs; opening to spiritual, mystery, unknowns- allowing for miracles Dorthea Orem: Self-Care Mode - Help the patient maintain or regain autonomy The nurse first needs to assess and determine the patient’s needs/ What can the patient do and what does the patient need to have help with? What are the patient’s self-care deficits? Imogen King: Theory of Goal Attainment - The nurse and the patient work together to identify and obtain goals. A systems approach is used to obtain those goals: personal system, interpersonal system, social system Sister Collista Roy: Roy’s Adaptation Model - The environment may be altered to help the patient adapt or have adaptive behavior. The focus is on adaptation. The nurse develops nursing diagnoses to guide goal setting and interventions which focus on adaptation. The nurse may modify the environment to enhance adaptation. Hildegard Paplau: Theory of Interpersonal Relations in Nursing - The focus is the relationship and the nurse, not just the patient 3 Phases: Orientation, Working and Termination ○ Orientation - establish trust and agree to work together ○ Working - determine goals to address patient needs and problems ○ Termination - end of patient and nurse relationship in a therapeutic manner Goals: 1-Survival of the Patient; 2-Patient’s understanding of his/her health so the nurse and patient can develop new behavior patterns Ida Orlando: Nursing Process Theory - The focus is on the interaction between the nurse and the patient. The nurse observes the patient and determines what needs the patient has and how to provide positive outcomes for the patient using the nursing process. Four key concepts: the patient's behavior, the nurse's reaction, the nurse's activity, and the dynamic nurse-patient relationship. Madeleine Leininger: Transcultural Nursing Theory - The focus is on making sure the nurse has an understanding and respect of the patient’s cultural preferences The three core principles of Leininger’s theory include: Cultural preservation or maintenance, Cultural care accommodation or negotiation, Cultural care repatterning or restructuring Sunrise Model represents different factors that can influence care, including: Technological factors, Religious and philosophical  factors, Kinship and social factors, Cultural values, beliefs, and lifeways, Political and legal factors, Economic factors, Educational factors ○ Communication Interpersonal skills Hildegard Peplau focused on the importance of the nurse-patient relationship integrating interpersonal skills that include the development of self awareness, non judgemental acceptance of others, communication, and collaboration skills What is appropriate and what is not Appropriate communication = empathy, open-ended questions, giving information, reflection, silence, use of verbal and nonverbal language, therapeutic techniques, providing an interpreter or translator when needed Levels of communication Intrapersonal = self Interpersonal = one on one Small group = small number of people Public = interact with an audience Electronic What causes breakdown in communication Falling to see uniqueness Falling to recognize levels of meaning Using value statements and cliches Giving false reassurance Failing to clarify ○ Phases of nurse-patient relationship Orientation Establish level of trust in nurse/patient relationship Acknowledge nurse/patient individuality Identify patient needs and problems Agree to work together Determine time frame Working Determine goals to address patient needs and problems Recognize patient effort and resistance Continue to practice effective communication Termination Complete nurse/patient relationship Deal with feelings Maintain professionalism ○ When/who to report things that should not happen Must be reported to supervisor, manager, or state board of nursing; do not attempt to talk it out with coworker ○ Self-awareness: basic to effective interpersonal relationships and is especially important in the nurse-patient relationship Professional boundaries First addressed by Florence Nightingale; the spaces between the nurse’s power and the client’s vulnerability Boundary violations occur when there is confusion between the needs of the nurse and those of the patient Personal/Structural reflections Taking time to focus on their own thoughts, feelings, actions, and beliefs ○ SBAR Used as a form of communication between healthcare personnel Situation, Background, Assessment, Recommendation ○ Healthcare reform - know the abbreviations Healthy people 2030 (HP2030) - a science-based program that sets forth national objectives focusing on health promotion and disease prevention every 10 years State Children’s Health Insurance Program (SCHIP) 2009 - extended health insurance coverage to children whose parents cannot health insurance coverage Affordable Care Act (ACA) 2010- increase access to health insurance coverage Health Information Technology Act (2009) - incentivized the meaningful use of EHRs and strengthened the privacy and security provisions of HIPAA Health Equity and Accountability Act of 2022 (HEA) - addresses and reduces health disparities among racial and ethnic minorities No Surprises Act 2020 - designed to protect patients from unexpected medical bills by limiting the amount patients can be charged for such services ○ Categories of healthcare services - what does it look like Healthcare promotion and maintenance - Assist patients to remain healthy, prevent disease, and injuries detect disease early, and promote healthier lifestyles Illness Prevention - assist the patient reduce the impact risk factors, such as family history disease and genetic dispositions, on their health and well-being Diagnosis and treatment - advances in medical technology have improved diagnosis and treatment, but can make patients feel dehumanized. Rehabilitation and long-term care - help restore the patient to the fullest possible level of function and independence after injury or illness ○ Classifications of health care agencies Governmental (Public Agencies)  Local governmental State governmental Federal governmental Voluntary (private) agencies Nongovernmental organizations Not-for-profit agencies For-profit agencies ○ Levels of healthcare services - know an example Primary Entry into the system; treatment of temporary health problems that do not require hospitalization (e.g. ER) Secondary Specialists such as cardiologist or pulmonologist Tertiary Long term care such as rehabilitation, acutely ill, terminally ill Subacute Goal oriented and comprehensive inpatient (acute, injured, disease exacerbations ○ Healthcare facilities accreditation program: joint commission ○ UAP - unlicensed assistive personnel Professional RNs retain accountability for acts delegated to another person; can only delegate independent nursing activities (provision 4) ○ Organization structure within healthcare agencies Board of directors Chief Executive Officer (CEO) Medical staff governance Medical staff Nursing staff governance Nursing staff ○ Metaparadigm of nursing: person, environment, health, and nursing ○ The foundation or ‘bones’ of nursing: person, environment, and health ○ Components of system: Input: The “raw” materials such as information Example of input in a clinical setting: A patient arrives at the hospital with chest pain. Throughput: consists of the processes a system uses to convert the input into a form that can be used by the system or by the environment. Example of throughput in a clinical setting: the diagnostic procedures such as an EKG. Output: The end result or product of the system. Example of output in a clinical setting: The procedure results. Evaluation: Measuring the success or failure of the output and consequently the effectiveness of the system.  Example of evaluation in a clinical setting: asking questions like “Did the process work?” and “How is the patient responding to the treatment?” Feedback: Process of communicating what is found in the evaluation of the system. The information is then given back into the system to determine whether the purpose, or end result, has been achieved. Example of feedback in a clinical setting: do the medications need to be increased or decreased? ○ Systems: consists of several parts called subsystems. Subsystem example in a hospital (system): departments such as nursing, medicine, imagining, informatics, laboratory, etc. Open system: promotes the exchange of matter, energy, and information with other systems and the environment Closed system: does not interact with other systems or the environment Suprasystem: the larger environment outside the system Example of suprasystem for a hospital: specialty clinics ○ Maslow’s Hierarchy of Needs: you cannot progress unless you meet the first one. Everyone's needs are different. Physiological needs: Food, oxygen, rest, activity, shelter, and sexual expression Safety Needs: Both physical and psychological safety. A predictable environment with relative freedom from fear and chaos. Social needs: love and belonging. Each person needs close, intimate relationships. A place in society. Esteem needs: the need to feel self-worth, self-respect, and self-reliance. Self-actualization: the HIGHEST level. People have to realize their maximum potential; they use their talents, skills, and abilities to the fullest extent possible and are true to their nature. This fluctuates throughout life. ○ Homeostasis: dynamic balance achieved by effectively functioning open systems. Internal stability. Adjustments occur automatically. Disruption leads to illness or disease ○ Health: viewed as a continuum. It is affected by what you believe ○ Health behaviors: choices and habitual actions that promote or diminish health Examples of health behaviors: eating habits, frequency of exercise, use of tobacco production and alcohol, sexual practices, and adequacy of rest and sleep. ○ Rosenstock health belief model: illustrates how people behave in relationship to health maintenance activities A cue to action or trigger event: propels a previously unmotivated individual into changing health behaviors Level of belief in one's self-efficiency: High, promotes, low, lack of effort. -Social contract- ANA code of ethics -Philosophy: the study of the principles underlying conduct, thought, and the nature of the universe. -Philosophies of Nursing: statements of belief about nursing and expressions of values in nursing that are used as bases for thinking and acting -Theory: refers to a group of related concepts, definitions, and statements that describe a certain view of nursing. -Metaparadigm: the most abstract aspect of the structure of nursing knowledge. Discipline, person, environment, health, and nursing. -Conceptual model/framework: more specific organization of nursing phenomena than philosophies. Structure that makes clearer connections between concepts. -Propositions: are statements that describe linkages between concepts. They propose an outcome that is testable in practice and research. Concept mapping -Nursing phenomenon: a term given to describe an idea or response about an event, a situation, a process, a group of events or a group of citations. -Nursing Theory: an organized framework with concepts and purposes to guide the practice of nursing. -Levels of Nursing theory from abstract to specific: nursing metaparadigm, grand theories, middle range theories, and practice-level theories. -Cross-sectional links: are associations between nursing diagnoses. “This is related because ___ can lead to/ causes ___” -Hub: medical diagnosis -Spokes: nursing diagnosis -Three parts: actual problem. r/t and aeb -Two parts: RISK FOR or health promotion. -SMART goals: for the patient -1 Respect for inherent dignity: the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person -2 Commitment to the patient: the nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. -3 Advocacy for the patient: the nurse promotes, advocates for, and protects the rights, health, and safety of the patient. -4 Accountability for nursing practice: the nurse has authority, accountability, and responsibility for nursing practices; makes decisions; and takes action consistent with the obligation to promote health and provide optimal care. -5 Duty to self and personal integrity: the nurse owes the same duties to self as to others including the responsibility to promote health and safety, preserve integrity and character, maintain competence, and continue personal and professional growth. -6 Improvement of the ethical environment: the nurse establishes, maintains, and improves the ethical environment of the work setting and conditions of employment conducive to safe, quality health care. -7 Advancement of the profession: the nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. -8 Collaboration for human rights: the nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities -9 Advocacy for the profession and public health: the profession of nursing, collectively through its profession, and integrating principles of social justice into nursing and health policy. ○ Nurse practice act and objectives Defines standards and scope of professional nursing Describes the authority, power, and composition of the board of nursing Defines educational program standards Sets the minimum educational qualifications and other requirements for licensure Determines and protects the legal titles and abbreviations nurses may use Provides for disciplinary actions of licenses for certain causes ○ QSEN Patient centered care (PCC): recognize the patient to 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 (T&C): function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care Evidence-based Practice (EBP): integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care Quality Improvement (QI): use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve quality and safety of health care systems Safety (S): minimizes risk of harm to patients and providers through both system effectiveness and individual performance Informatics (I): use information and technology to communicate, manage knowledge, mitigate error, and support decision making ○ How to keep the license - complete continuing education requirements Ex: workshops, conferences, short courses In NC for every 2 years, 15 hours minimum required to keep licensure as a nurse ○ Enhanced Licensure Compact (eNLC): allows RNs to have one license yet practice in other compact member states without an additional license in the state of employment ○ Federal legislation: HIPAA and patient confidentiality ○ Types of law in the American legal System: Common Law: judges ruling based on precedent cases to resolve disputes such as negligence and malpractice  Statutory Law: written law that outlines what is needed to practice as a nurse; for example the nurse practice act is a statutory law that outlines scope of practice Administrative Law: state board designs what you can do in practice ○ Six ethical principles regarding patients Autonomy: deciding to refuse treatment; giving consent for treatment or procedures; and obtaining information regarding results of diagnostic tests, diagnosis, and treatment options. Beneficence: hiring a sitter for a patient who frequently falls out of bed Nonmaleficence: Not harm. Classic examples of this are chemotherapy and bone marrow or stem cell transplantation procedures. Justice: Everyone deserves the same level of care regardless of their situation. Fidelity: only a qualified nurse, appropriately trained and educated, and passing a standardized national examination, can practice nursing. Practices within the scope of practice. Veracity: Being honest with a patient. “Dr. Roberts always prefers to discuss her findings with her patients directly. I will call her and ask when you can expect her to make rounds tonight to talk to you.” ○ Professional organizations ANA is the largest Purpose- advocate and improve Three types: Broad-purpose professional organizations, specialty practice organizations, special interest organizations. How do you join (select all) Find out more about the organizations mission and activities Speak with current members Ask yourself the right questions Benefits Why: network, pursue continuing education and certificates, stay informed on professional issues, leadership skills, influence health policy, and job security. ○ Nurses legal responsibilities (5) Informed consent - all patients or their guardians must be given an opportunity to grant informed consent before treatment unless there is a life-threatening emergency. Must be given voluntarily, they must have the capacity and competence to understand, and they must be informed. Confidentiality- The protection of private information gathered about a patient during the provision of healthcare services. Delegation Malpractice - it's what you do/don't do. ON PURPOSE Assault and battery- assault (threat) battery (action) ○ 5 rights of Delegation Right task  Right circumstance Right person Right direction/communication Right supervision/evaluation ○ Negligence- is the outcome of malpractice. ON ACCIDENT ○ Health policy - health promotion, illness prevention, nursing practice. ○ Ethical dilemmas Dilemmas resulting from personal value systems Dilemmas involving peers’ and other professionals’ behavior Dilemmas regarding patients’ rights Dilemmas created by institutional and social issues Dilemmas created by patient data access issues