EXAM 1 study guide - Lecture notes exam 1 notes PDF

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EXAM 1 study guide Upon completion of the unit, the student will be able to: 1. Describe the historical background of nursing, definitions of nursing, and the status of nursing as a profession and as a discipline. Historical Influences on Nursing Knowledge The development of nursing knowledge has been influenced by the early work of Florence Nightingale, later nurse researchers and theorists, and societal changes. Nightingale’s Contributions Nightingale influenced nursing knowledge and practice by demonstrating efficient and knowledgeable nursing care, defining nursing practice as separate and distinct from medical practice, and differentiating between health nursing and illness nursing (see Chapter 1 for further information). The training of nurses was initially carried out under the direction and control of the medical profession. Because the conceptual and theoretical basis for nursing practice came from outside the profession, nursing struggled for years to establish its own identity and to receive recognition for its significant contributions to health care. Societal Influences on Nursing Knowledge Most early schools of nursing established in the United States were adapted from Nightingale’s model. There was no planned educational curriculum; instead, knowledge was acquired from lectures by physicians and through practical experience by caring for sick people in hospitals. This service orientation for nursing education remained the strongest influence on nursing practice until the 1950s. Nursing care was carried out under the control and direction of the hospital administration and physicians practicing in that hospital. Nursing care was based on traditional ideas about following orders, as well as on common wisdom about caring for others based on either “common sense” or widely accepted scientific principles (Chinn & Kramer, 2015). As a result, nursing knowledge remained undeveloped and fragmented. During the first half of the 20th century, a change in the structure of society resulted in changed roles for women and, in turn, for nursing. As a result of World Wars I and II, women increasingly entered the workforce, became more independent, and sought higher education. At the same time, nursing education began to focus more on education than hands-on training, and nursing research was conducted and published. As women became more independent and assertive, nursing’s need for a clearly defined identity based on unique contributions to the health care system emerged. In the mid20th century, the idea of nursing as a science became more generally accepted, and philosophic beliefs and a knowledge base for nursing practice began to evolve. Today the

proliferation of graduate nursing programs, including the PhD in nursing, demonstrate society’s acceptance of nursing science. Nightingale environmental theory Light, nutrition, clean air, clean water, clean environment, clean bedding. 2. Describe the various levels of educational preparation in nursing. LPN RN associate ASN RN BSN RN MSN DNP

3. Describe key elements of the developing nurse.

Cultural competence takes time. It involves developing awareness, acquiring knowledge, and practicing skills. Negligence and malpractice are unintentional torts. Liability involves four elements that must be established to prove that malpractice or negligence has occurred: duty, breach of duty, causation, and damages. The nurse may be involved in legal proceedings as a defendant, a fact witness, or an expert witness. 4. Identify foundational competencies to provide nursing care. The diverse society in which nurses care for others mandates the ability to provide culturally competent care. An understanding of basic human needs and the individualized definitions of wellness and illness prepare the nurse to integrate the human dimensions—the physical, intellectual, emotional, sociocultural, spiritual, and environmental aspects of each person—into nursing care to promote wellness, prevent illness, restore health, and facilitate coping with altered function or death.

5. Discuss the effects on nursing practice of nursing organizations, standards of nursing practice, nurse practice acts, code of ethics, and the nursing process. used to describe a competent level of nursing care as demonstrated by the critical thinking model known as the NURSING PROCESS.

nursing process: five-step systematic method for giving patient care; involves assessing, diagnosing, planning, implementing, and evaluating standards: rules or guidelines that allow nurses to carry out professional roles, serving as protection for the nurse, the patient, and the institution where health care is given

profession: an occupation that meets specific criteria including a well-defined body of specific and unique knowledge, a code of ethics and standards, ongoing research, and autonomy 

Nursing is recognized as a profession with a unique body of knowledge, service orientation, code of ethics, autonomy, and self-regulation.

6. Compare and contrast systems theory, adaptation theory, and developmental theory. Common to the interdisciplinary base for nursing theory are general systems theory, adaptation theory, and developmental theory. Developmental theory outlines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death. Although the pattern has definite stages, the progress and behaviors of a person within each stage are unique. Heredity, temperament, emotional and physical environment, life experiences, and health status influence the growth and development of a person. Adaptation theory how we adapt. Developmental theory how we grow and develop.

7. Discuss the purpose of nursing research. Nursing research, broadly defined, encompasses both research to improve the care of people in the clinical setting and the broader study of people and the nursing profession, including studies of education, policy development, ethics, and nursing history. Nursing research is conducted by quantitative and qualitative methodologies. Evidence-based practice (EBP) in nursing is a problem-solving approach to making clinical decisions, using the best evidence available (considered “best” because it is collected from sources such as published research, national standards and guidelines, and reviews of targeted literature). EBP blends both the science and the art of nursing so that the best patient outcomes are achieved.

8. Describe evidence-based practice in nursing, including the rationale for its use. evidence-based practice (EBP): nursing care provided that is supported by sound scientific rationale evidence-based practice guideline: guideline guidelines written by a panel of experts that synthesize information from multiple studies and recommend best practices to treat patients with a disease, a symptom, or a disability

9. Recognize ethical issues as they arise in nursing practice.

nursing ethics: a subset of bioethics; formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments.

10. Use an ethical framework and decision-making process to resolve ethical problems. Nurses learn to practice ethical conduct by cultivating the virtues of nursing, understanding ethical theories that dictate and justify professional conduct, and becoming familiar with codes of nursing ethics and standards for professional nursing conduct

11. Describe laws affecting nursing practice. 

A variety of safeguards are in place in the health care system, both to protect nurses from exposure to legal risks while performing the duties of their role and to ensure that the practice environment is geared toward enhancing patient and personal safety. These safeguards include competent practice, informed consent or refusal, contracts, collective bargaining, patient education, safe execution of physician orders, safe delegation, legally prudent documentation, adequate staffing, whistle-blowing, professional liability insurance, risk management programs, incident reports, sentinel events, never events, the Patient’s Bill of Rights, and Good Samaritan Laws.

12. Describe the professional and legal regulation of nursing practice.

nurse practice act: law established to regulate nursing practice nursing: profession that focuses on the holistic person receiving health care services and provides a unique contribution to the prevention of illness and maintenance of health Four concepts common in nursing theory that influence and determine nursing practice are (1) the person (patient), (2) the environment, (3) health, and (4) nursing. Each of these concepts is usually defined and described by a nursing theorist, and although these concepts are common to all nursing theories, both the definitions and the relations among them may differ from one theory to another. Of the four concepts, the most important is that of the person. The focus of nursing, regardless of definition or theory, is the person

Explore the concepts of health, wellness, illness, and disease.

Heath is determined by each individual,, How people feel. Not just the body. Mental, social wellbeing are all part of health. Wellness the process of which people are changing, focused toward maximus an individual potential Self-concept someone own individual expects of themselves, self-esteem. illness is the response of a disease. Feeling and symptoms. Illness is frequency process where function is altered Disease pathological change in structure or function of the body 1. Describe the inter-relationship of factors that affect health.

2. List the different levels and types of basic human needs according to Maslow’s hierarchy. 3. Lower-level needs MUST BE MET before higher needs can be achieved Physiological Needs: -Most basic, must be met to maintain life -Food, air, water, temperature regulation, elimination, rest, sex, physical activity Safety and Security Needs: -Physical: Protection from physical harm (falls, infection) and having adequate shelter (housing with sanitation, heat) -Emotional: Freedom from fear and anxiety—feeling safe in physical environment and relationships Love and Belonging Needs: -Strives for meaningful relationships with others -Feeling of belonging (family, peers, community) Self Esteem Needs -Comes through a sense of accomplishment and recognition from others -Brings confidence and independence Self-Actualization Needs: -Need to reach your full potential and to act unselfishly -Develops wisdom and knows what to do in variety of situations >Cognitive Needs: to know, understand, explore >Aesthetic Needs: for symmetry, order, and beauty Transcendence of Self:

-Drive to connect to something beyond one's self -To help others realize their potential

4. Summarize key concepts of health promotion and illness prevention.

health promotion: behavior of an individual motivated by a personal

desire to increase well-being and health potential Examples of models of health promotion and illness prevention include the health belief model, the health promotion model, the health–illness continuum, and the agent–host–environment model. 5. Distinguish communication patterns that support a caring relationship.

CUS model C is for I’m Concern that U is for I’m Uncomfortable with S is for this is a safety issue. We need to

6. Explain the importance of patient education and counseling as tools to improve quality of life for individuals and groups.

counseling: giving guidance, assisting with problem solving 7. Provide a basic overview of the health care delivery system in the U.S.A. IOM institute of medicine. 6 outcomes Institute of medicine 8. recommendations for health care system. 9. Steep 10. Safety (pt ID) 11. Timely (time frame which is care and medication is administer) 12. Effectiveness is it working 13. Efficacy14. Equitable15. Pt centered care 16. KV of system 17. Access- keep people get services when they need them 18. Affordability – are getting u getting what u paid for 19. Quality- degree which heath services increase the likely hood of health desired outcomes 20. We compare with 35 industrial country

IOM core competencies include what 5 standards? 1) Pt centered care 2) Interprofessional 3) Evidence-based practice 4) Quality improvement 5) Utilize informatics 21. Outline basic concepts of informatics utilized by the professional nurse.

Informatics- computer science blend with nursing * management of analytic science to ID define, manage and communicate data, information, knowledge and wisdom in the nursing practice. Concepts are: system usability, system optimization, standard terminologies, interoperability, secure and privacy, hippa

Factors affecting learning Age and developmental level Family support networks Financial resources Cultural influences Language deficits Health literacy level The helping relationship American Nurses Association (ANA)- The American Nurses Association defines nursing as 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. The American Association of Colleges of Nursing has created the clinical nurse leader role for master’s-prepared nurses. The American Nurses Association (ANA) has released a revised Decision Tree for Delegation by Registered Nurses that can be used by RNs practicing in all settings across the continuum of care.

*The nurse's primary concern is the good of the patient. *Nurses must be competent *Nurses demonstrate a strong commitment to service. *Nurses believe in the dignity and worth of each person. *Nurses constantly strive to improve their profession. *Nurses work collaboratively within the profession. the official professional organization for nurses in the United States that focuses on establishing standards of nursing to promote high-quality care and working toward licensure as a means of ensuring adherence to the standards purposes of nursing care- health promotion, illness prevention, health restoration, end of life care.

Nursing process- the model that represents the standard of nursing practice. Assessment ,Diagnosis, Planning, Implementation, Evaluation. National League for Nursing (NLN)- first nursing organization with a goal to establish and

maintain a universal standard of education State boards is responsible- 1. Defining the practice of professional nursing

2. Approving nursing education programs 3. Establishing criteria that allow a person to be licensed as an RN or LPN 4. Developing rules and regulations for guidance to nurses 5. Enforcing the rules that govern nursing practice SENC- safe, effective, nursing, care Altruism concern for the well-being of others. Professional nursing values- Altruism, autonomy, human dignity, integrity and social justice. Nursing Practice Act-state law that describes the nursing scope of practice and serves as guide when facilities develop job descriptions Nurse Researcher- conducts evidence-based practice and research to improve nursing care and

further define and expand the scope of nursing practice Theory- Defines and illustrates concepts and their relationships. Answers questions "what is this?

How does this work?" 4 steps of theory Identify a problem/ gap Collect relevant data on the problem Formulate hypotheses to explain the problem Test the hypotheses Paradigm- a model; an example shared understanding and assumptions about reality Evidence-based practice (QSEN) nursing care provided that is supported by sound scientific rationale. QSEN-competencies

Patient-Centered Care Teamwork and Collaboration Evidence-Based Practice Quality Improvement

Safety Informatics Informatics- use information and technology to communicate, manage knowledge, mitigate error,

and support decision making 4 aims of nursing Promote health Prevent illness Restore health Facilitate coping with death or disability Factors affecting wellness Environmental, emotional, financial, intellectual, occupational, physical, social, spiritual. Factors affecting health Education level, cognitive abilities, socioeconomics, genetic inheritance, development level, age and gender, race/ ethnicity and culture, lifestyle environment. What encompasses nursing as a professional discipline? Well defined body of specific & unique knowledge Strong service orientation Ongoing research= evidence-based practice Code of ethics

Role of the nurses Caregiver, advocate + leader, collaborator, teacher, counselor, researcher, communicate. Build trust and rapport, listen, strive to communicate with sensitivity, compassion, comptence Maslow

6 C of caring Competence, confidence compassion, conscience, commitment, comportment Factors that affect health of patient Biology, lifestyle, environment, health care system, the system Stages 4 stages of illness behavior 1) 2) 3) 4)

Experiencing symptoms Assuming the sick role Assuming the dependent role Achieve recovery & rehibition most likely completed at home resume normal activities

Primary prevention- action taken to make pt resistant or the environment less harmful preventive (vaccine/ removal of throw rugs) early diagnosis, treatment. Slow or prevent (eating a healthy diet, safe sex Secondary prevention- screening for early of disease (colonoscopy) Restoration & rehabilitation. Education to detect disease. (self breast exam) Tertiary prevention- already have disease efforts to improve care to minimize progression of disease avoid disability. Health promotion & protection. (sugery taking antibiotic to prevent infection RN delegation Right task Right Circumstance Right person Right direction and communication in writing or orally or both Right supervision and evaluation

Heath is determined by each individual, How people feel. Not just the body. Mental, social wellbeing are all part of health. Wellness the process of which people are changing, focused toward maximus an individual potential Self-concept someone own individual expects of themselves, self-esteem. Therapeutic communication- build and maintain the relationship by what we say- therapeutic touch is a way to communicate Use active listening . Helping relationship- is to fill their basic needs, build a repour, being empathic. Showing sensitivity Cognitive- can people store information and recall Pscychmotor- hands on learning Affective- emotional The communication process Validate that the patient is understanding the information in their own words. Interpersonal- self talk Interpersonal- 2 or people talking Group – small group, organization Group dynamic-effective vs ineffective Nonverbal – 50-80% nonverbal communication. Eye contact is important. Facial expression are important. Poster is important. Avoid hand gestures Written- start email with a greeting not just hey. Electronic give Give info on 5th grade level. Do not use slang Factor affecting communication Developmental level, sociocultural difference, space and territoriality, physical, mental and emotional state, Gender, environment Challenges in communication Impaired verbal communication, lack of respect, poor listening, judging, closed question With colleagues incivility, aggressive, lateral violence. Huddle- report at umass- share communication BATON- shift report SBAR – I- introduce your self P- pt name and id A-assessment. S-situation. S-safety concerns or crucial lab reports. B- background. A-actions taken. T- timing. O- ownership. N- next what the plan. Situation. Background Assessment Recommendations. Check back to make sure the information was received. Repeating communication back....