Foundations Final Review PDF

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Foundations Final Review Powers of caring: Transformative power- nurse can help client gain sense of self control Integrative power- reintegrate patient into own social world, continue meaningful life despite limitations Advocacy power- act in patient’s behalf, interpret necessary information to client and physician, removes obstacles Healing power- establish healing relationship and climate, mobilizes hope and resources, help client find support Participative/affirmative power- finds meaning in specific events, nurse experiences pain, strength and affirmation Problem solving power- problems require perceptual ability, involvement and attentiveness, provides sensitivity cues Declaratory order- issued by BON, determines eligibility for initial licensure Nursing theories- differentiate nursing from other disciplines, provide means of testing knowledge through research Nursing paradigm- Person, Health, Nursing, Environment Nightengale- role of nurse was to place the patient in the best condition for nature to act upon him Clinical judgement providing basis for selection of interventions to achieve outcomes- NANDA nursing diagnosis Offers common language between nurses to facilitate communication and care planning- nursing diagnosis 4 stages of analysis 1. recognize pattern or trend 2. cluster defining characteristics 3. compare with standards 4. make reasonable conclusion problem identification1. identify broad focus area write nursing diagnosis in terms of response

2. choose narrow specific statement

write in legally advisable terms use d/t effects of, avoid inadequante express nursing diagnosis in terms that can be changed 3 aspects of planning 1. choose interventions 2. patient-centered goals purpose of planning- provide individualized care that realistic and measurable outcomes designed to help patient and family.... rules for establishing priorities

1. regain or improve health status

3. establish desired outcomes 2. adjusted to reduced level of health

3. make informed choices

4. avoid injury

1. life threatening before ADLs

2. immediate needs before teaching needs

5. adapt to decreased functioning 3. pain relief

considerations for priorities- culture, values, beliefs, cost, resources available, laws, policy goal- desired result of nursing care made as broad statement addressing problem in nursing diagnosis components of goal- subject, action verb, qualifier specific measurable realistic statements of goal attainment- outcome criteria demonstrate reduction or alleviation of problem- actual diagnosis maintenance of current status of health or functioning- at risk diagnosis outcome domains- cognitive, psychomotor, affective associated with acquired knowledge or intellectual abilities- cognitive domain developing motor skills (Demonstrate, perform, practice, walk)- psychomotor domain change attitude, feelings or values (express, written, relate, communicate)- affective domain Nurse develops plan of care that prescribes interventions to attain outcomes- ANA standard for interventions Activities planned to help patient achieve identified outcomes- interventions Types of interventions 1. environmental management 2. dependent 3. nurse initiated/physician ordered 4. nurse ordered criteria for interventions- safe, congruent, effect etiology, realistic, important to patient safe environment, clean, well lit, wall calendars- environmental management scheduled procedures, medications, IV therapy- dependent interventions nurse request for restraints or catheter, prn orders, strength decisions- nurse initiate, interdependent interventions rules or principles which govern right conduct- ethics values and principles governing nursing practice, conduct and relationships- nursing ethics beliefs that influence one's thinking and actions- values moral principles that can be used in assessing what is morally right or wrong- ethical principles philosophy of ethics used to understand.... human interactions 40

Ultilitarianism- teleoligical theory, "greatest happiness theory", weigh consequences, greatest good for greatest number Deontology- based on moral duty, philosopher KANT, principle or motivation Natural law- morally right when in accord with nature, promote good, avoid evil Feminist ethics- focus on inequalities, practical solutions Beneficence- obligation to do good, not harm, act in best interest Autonomy- make own decisions Fidelity- be faithful to obligations and agreements Nonmaleficence- do no harm, hippocratic oath, least harmful interventions Veracity- telling the truth ANA code for nurses- Practice with compassion, Primary commitment to patient, Maintain professional relationship ethics used to.. prevent disease, promote health, restore health, alleviate suffering Approach and individual appraisal of values- Louis Ruth's definition of concept Steps of ethical decision making 1. massage dilemma 2. outline options 3. review criteria 4. resolve dilemma 5. affirm position 6. evaluate Dorthea Dix- Advocate for reform of mental health care, First superintendent for Union nurses, Appointed by Lincoln Theodur and Fredricka- Opened Kaiserworth school to train nurses Gertrude Reichardt- first student of kaiserworth Florence Nightengale- Mother of modern nursing, recruited during Crimean war, lady with the lamp, awarded victorian cross Goals of Florence Nightengale- Establish school of nursing, Reform army sanitation in England Mother Bickerdyke- Surveyed battlefields at night for wounded soldiers59 Elizabeth Blackwell- First woman physician Linda Richards- First trained nurse in America First African American nurse- Mary Mahoney Founded American Red Cross- Clara Barton Founded Hull house- Jane Addams Isabel Hampton- Principal of training school, First ANA president Goldmark report- nursing education should be separate from nursing service Stewart- divided nursing into pioneering, expansion, stress and turmoil Lillian Wald- organized Henry street settlement, school nurses, home visits by nurses 1903- first nursing license in U.S 1912- 8 hour work law applied to nursing students Adelaide Nutting- First nursing professor 1909 Nursing Practice Act- law passed by texas legislature defining scope of practice72 Nursing practice act: established board, ammended only by legislature, to protect public, all nurses responsible for knowing nurse act Functions of board of nursing- regulate RNs and LVNs, adopt rules, take disciplinary action, issue position statements, license nurses 2007 Board of nurse examiners becomes... texas board of nursing "Protect and promote welfare of people by ensuring competent nurses practicing safely"- Tx BON Mission Statement Members of BON- appointed by governor, confirmed by senate, responsible to public, licensees and government nursing regulation = government oversight Professional organizations- Responsible to members, Serve interest of nurses, Lobby legislature Reasons to go before the board- peer review, evaluation of practice in atmosphere of collegiality, lawsuit brought on by plaintiff Who must have peer review committee? agencies employing 10 or more nurses Peer review committee- affords due process, reviews only RNs, 3/4 members are RNs, Only RNs vote BON rule 22: RN has duty to evaluate pt status, institute care, stabilize condition and prevent complications

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Eight-hour shift versus 12-hour shift Introduction to shift work Extended shifts are “any system of fixed working hours more than eight hours in duration which results in a working week of less than five full days of work a week” Nursing history of 12-hour shifts • More research 1980s: understaffed hospitals • Safety precautions Goals: Increase recruitment rates Increase retention rates Maintain adequate nurse-patient ratio Benefits of 12-hour shifts From administration standpoint: Effective way to recruit prospective nurses Lower staffing costs Provide continuity of staffing and patient care From nurse standpoint: More time recreational time Less travel time and costs More time with family Concerns surrounding 12-hour shifts Post-test question #1 FATIGUE! • What were the goals 12-hour shifts originally? Select all Poor performance that apply. Decreased patient satisfaction • A. reduce understaffed hospitals Potential for job burnout • B. increase recruitment rates Health complications • C. improve patient care continuity Why still use 12-hour shifts? • D. increase retention rates Maintaining appropriate balance between nurse and Post-test question #2 patients • Which is not a perceived benefit of 12-hour shift? Select Resistance to change all that apply What can management do? • A. less travel time Promote adequate rest • B. increased time with family Ending shifts on time • C. increased patient errors Respect days off • D. decreased productivity A look at the research Post-test question #3 Family support • What is the MAJOR concern surrounding 12-hour shifts? Staffing conditions • A. increase in job satisfaction Age • B. increased patient care errors Job experience • C. fatigue Time of day • D. potential for burnout Where do we go from here?

Pediatric Nursing & Children with Autism What is Autism? Repeating questions may further confuse them Copious noise Definition: A disorder including deficits in: social skills, Sight communication, sensory tolerances, and abilities to handle Over/under stimulating colors diversions in usual routines. Newly recognized by the DSM 5 Lights as its own category of disorders Extensive commotion Autism Statistics Touch 1 in 88 American children Extremely sensitive 1 in 54 boys Don’t like being touched 1 in 252 girls Certain fabrics, materials, etc. Affects 2 million individuals in the US Need stimulation Social/Communication Barriers Routine Interruption = Meltdowns/ inability to function Physically and emotionally distant Trips to the hospital are a HUGE change in routine Many do not develop any social attachments Food/Bedtime schedules Speech impairment TV programs Inappropriate remarks Hygiene, playdates, etc. Lack of eye contact Nurse Interventions Sensory Barriers Hearing Social/Communication Barriers

Assess from the very beginning Identify ability to sustain social interactions Limit amount of people/healthcare team in the room at one time Take into consideration what parent’s are concerned about- they know their kids best! Don’t take personal offense if a child seems distant in a brand new setting Sensory Barriers Always assess! Remove excessive noise/ keep tv’s off Remove over-stimulating color posters Flashcards of procedures Other visual representations Allow children to touch materials when allowed Material preferences Routine Interruption Barriers Ask about eating, bedtime, playtime, schedules Stick as closely as you can to home schedules Implement schedules with PT/OT/physician/lab visits

Encourage independence in daily activities Let them know what is about to happen

Post-Test What is autism? A disorder including deficits in: social skills, communication, sensory tolerances, and abilities to handle diversions in usual routines What can the nurse implement to help autistic children overcome communication barriers? Assess each individual child’s ability of communicating and implement measures to meet them at their level What can the nurse implement to help autistic children handle possible sensory overload? Remove overstimulating colorful posters, loud noises, and use flashcards or other visual representations to help the child understand any procedures

Nursing Role in Bioterrorism: Preparation and Interventions Performed by Nurses in Combating Bioterrorism Bioterrorism Defined: “Use of biologic agents to cause disease or death in human beings, animals, or plants” respond to emergency History • Siege of Kaffa in 1346: Tartar forces used plague• How much am I obligated to treat or provide care as contaminated corpses over city walls across enemy part of my professional duty? lines • How much am I responsible as professional in • Serious issue and threat worldwide since 09/11/11 providing care for patients affected by bioterrorism? Factors that support the transmission of pathogens • Me (and my family) or the world? Level of preparedness • Natural disasters • Questionnaires to nursing students and post-graduate • Ease of travel nurses working in Region Abruzzo • Weather conditions • Identify pathogens commonly used for Healthcare response bioterrorism • CDC reinforce careful surveillance of: • unusual disease occurrences Know: their distinguishing characteristics, • mode of transmission, existence of preventative • Sudden growth of illnesses measures against the pathogens, and • Triage nurses the 1st healthcare professionals to take precautions and interventions best taken during care of patients with unusual diseases emergencies • Need to be competent and trained to recognize Result: < 50% of the participants knew the • dangerous pathogen correct and appropriate precautions against each • Prevent further contamination of the pathogens biochemical agents • Most missed questions: infection Classification • Biochemical agents reclassified  class A, B, C (based control and decontamination procedures on likelihood of causing destruction) • Based on a survey done on Missouri nurses, it was Class A being the most dangerous and class C being • the least indicated that: • Although 97.5% agree it was beneficial to learn General response • Basic physiologic maintenance : Problem, ABC, VS, about bioterrorism protocols, 60% respondents never received bioterrorism education either Pain due to lack of resources or no interest in • Further assessment learning • Clinical manifestations • Disease progression • 1/3 report not reading any journal or article entries r/t bioterrorism preparedness • Need to discern specific s/s for the Barriers particular disease • Limited availabilityDependent on what kind of job • Isolation if necessary to prevent its spread • Notify appropriate authorities for further examination nurses have • Lack of financial support to attend special programs and preparation for possible outbreak • Lack of general resources • Nutritional, psychological support Overcoming the barriers Intentions • Nurses weigh risk of infectious disease BEFORE they Informing nurses the cause of an outbreak •

Providing practical preventative and treatments measures of the biochemical agents • Providing protection measures for the nurses’ lives and assurances of their family members’ safety • Incorporating bioterrorism into continuing education programs and nursing school curriculums Cost-effective Resources • Online training modules • PowerPoint presentations • Videos Nursing Interventions •

Appropriate PPE before entering the room? Gowns, gloves, masks • Keeping the patient hydrated • Controlling temperature • Assisting with breathing difficulty • Providing therapeutic communication with the patient and patient’s family What do you assess? • Oxygen saturation improves to 96% • Respiratory rate decreases to 22 • Patient reports “breathing is better” •

Bone Marrow Transplant Nursing The Management of the Patients Disease  “Patients are often isolated in their rooms for several weeks; visitors must wear gowns and masks”  Nurses must wear a surgical mask when seeing their patients. Also, the patients are in a hepa-positive pressure rooms (Jacobs, 2008).  Life vs. Death  Low WBC count of 100, normal amount is >4,000. So, every nosebleed and fall must be taken seriously Stress and Burnout the Nurse Experiences  Some days are more difficult than others. We get to know our patients quite well since we see them at least 3 days a week if not more. There is not one particular day that is worse than the others, you have days when you work harder and give bad results which is hard since we get to know our patients very well, like family.  Personal accomplishment contributes to the nurses satisfaction with their job Impact on Nursing: In order to take care of a patient wholly, the nurse must encompass an array of roles to provide a caring environment for the patients. Conclusion: As long as the nurse is compassionate, empathic, hardworking and able to multi-task, being a bone marrow transplant nurse will be a very satisfying career Post-Test Question 1- Main roles a BMT nurse plays?  To be the patients advocate throughout treatment and provide them with palliative care  Care for the patient only after the patients BMT treatment  Nothing, they just take the patients BP  To be a friend to the patient Post-Test Question 2 How important is it to keep a patient healthy after a BMT?  Not very important. A little fever is okay.  They are already sick, so it doesn’t really matter.  Very important! Take every cough/fall/bleed seriously.  Infection control is semi important. Post-Test Question 3- What positively affects BMT nurse?  Discussing their stressful days with their patients  The personal accomplishment of their job  Drinking a coffee before work  Talking about their patients to their friends

Bullying in Nursing What is Bullying? Bullying is defined as the misuse of power or position that undermines a person’s ability; or leaves them feeling hurt, frightened, angry, or powerless.(Barber, 2013) What Constitutes as Bullying at the Work Place  Bullying by exclusion  Unfair and destructive criticism  Humiliation  Plagiarism  Verbal Abuse  Destruction of personal property Bullying Can have effects on…  The nurse  The patient  The workplace  Bullying can be described as a chain reaction Effects on the Nurse  Can cause them to not like the job and quit  Effect physical health  Effect mental health  Self-Harm Effect on the Patient  With the nurse dealing with the costs of bullying on their health, the nurse can not focus on providing the patient with the best quality of care  Nurses may also take “sick” days due to increased stressrelated illness such as depression resulting from bullying, which can then lead to less nurses on staff thus decreasing the quality of care for the patient. Effect on the Work Place  Can cause nurses to leave their job  Lower staff morale  Lower job satisfaction Who are the Victims of Bullying? Nursing Students, New nurses How to Stop Bullying  Being proactive, such as reporting incidents. Most people are afraid to report due to fear that it will be used against them in the future.  Hospital Zero-Tolerance Policies

CARDIOVASCULAR NURSING

Background  American Nurses Association  fairly recent background  first standards and code of ethics defined with the help from  American Heart Association- Focused on the treatment of patients with cardiovascular diseases  Spent little time in prevention and early interventions Roles of a CV Nurse  Palliative care for end-stage patients  Ivany and While (2013)  Therapeutic communication  Teach  Give clinical advice  Monitor VS, give meds, and prepare patients for surgery. CPR and Family-Witness Resuscitation  CPR: “attempt to restore circulation and/or breathing in patients who experience an unexpected cardiac or respiratory arrest” (Reynolds & Croft, 2012, p. 35).  Family-Witnessed Resuscitation or FWR (Wendover, 2012).  Family and/or friends in the room  Pros and cons  Patients like it

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Family/friends like it



Staff does NOT like it

Timothy Majewski, a cardiovascular Registered Nurse at the Dallas, Texas Jack and Jane Hamilton Heart and Vascular Hospital  Rescue Team composed of 12 people 

Too much chaos, not enough room for family



RT wants “to have an environment that 

is conductive to the best care



[they]can give to the patient”.

Post- Test 1- Which organization helped define the 1st standards and code of ethics for CV nursing? o Board of Nursing o

American Heart Association

o

BU LHSON

o

Texas Board of Nursing

Post- Test 2 Which one is NOT a role of a CV nurse? o Palliative...