Lecture Notes, Introduction to Nursing PDF

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1004 review Be familiar with Canadian health care system.  Canadian health act: - Protect, promote, restore physical/ mental well-being of Canadian residents - Have principles that deliver/ co-deliver health services to targeted groups (aboriginal, RCMP, veterans) - Provide national policy and programming to PROMOTE: health & disease prevention (healthy environment, consumer safety, public health care program)  Primary health care - Foundation of Canadian health care system - Entry point to health care system - Its philosophy & model is to = improve health that support health care services - Has strong emphasis on principles of health promotion and disease prevention  Primary care - Entry to PHC - Treatment for what ails to a person at given time PHC PC - Health education - Personal health services of individuals - Nutrition - Maternal & child health - Family planning immunizations - Control of local endemic diseases * PHC extends beyond PC Romanow report  He believes that Medicare is SUSTAINABLE - Wants to modernize CHA - Recommends: - To improve access to rural area/aboriginals - Expand PHC - Strengthen home health care & drug coverage

Kirby report Believes that Medicare is NOT SUSTAINABLE - Believes that private sector should have stronger role in HC delivery - Concerned on health care costs on other programs

 5 levels of care: I. Health promotion - Enabling people to control & improve their health

Ex: run clubs, pre-natal care II. Disease and injury prevention - Prevention of illness that reduces risk factors Ex: WHMS, immunizations III. Diagnosis and treatment - Recognizing & managing clients existing health problems - 3 categories: Primary – first contact to HCS; decision-making and action to resolve health issue Secondary – hospital/ home setting; medical services from specialists & PC practitioners Tertiary – technical care for diagnosis & treatment; high technology IV. Rehabilitations - Focus on restoration of patients health Ex: speech therapy, physiotherapy V. Supportive care - For patients who have chronic/terminal illness a) Palliative care- for those with life-threatening illness b) Respite care- short term relief for families by HCP

Nursing roles

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 ARNNL - Regulate nursing profession in province & protect public - Go along with Registered Nurses Act - Responsible for: competent, compassionate & up to date health care for public - Self regulatory body Self-regulation - Recognize that profession if best qualified to determine its own standards of practice and education - Nurses know what’s best for their education and standards - ARNNL- change & implement policies to ensure that public receives safe, competent & ethical care Registered nurses act - Implemented by government for nurse practice and public awareness - PURPOSE: - Advance/ promote ethical & professional standards of nursing profession - Encourage proficiency & competency in nursing profession - Encourage members to participate in activities promoting health and well-being of public Standards of practice - Authoritive statement

Articulates conduct/ performance required of RN’s that serve to further define responsibilities set out in legislation and regulation - Its purpose is to identify level of performance expected of RN’s in their practice against which actual performance can be measured. Competency - The integrated knowledge, skills, judgment and attributes required of a registered nurse to practice safely and ethically in a designated role and setting. (Attributes include, but are not limited to, attitudes, values and beliefs.) -

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NURSES NEED TO UNDERSTAND THE STANDARDS & APPLY THEM IN THEIR FIELD

Ethics 

CAN’s Code of Ethics - Created by nurses to guide nurses practice - Statement of ethical values of nurses & their commitment to patients with health care needs & for those who need to receive it WHY IS IT SO IMPORTANT FOR NURSES TO HAVE CODE OF ETHICS?  Responsibility - Characteristics of reliability & dependability - Able to distinguish between right & wrong - By agreeing to act responsibly- nurses gain patients trust and colleagues trust  Accountability - Being responsible for action or being answerable to someone for something one has done - Nurses accountability: - Keeping up with professional laws, standards & regulations - Have to ensure that they have the skill to provide practice - Maintain their fitness to practice - Ensure that they can practice safely and competently - Sharing own knowledge with other nurses throughout MENTOSHIP/Feedback  Advocacy - Acting on behalf of another person - Speaking for those who cant speak - Intervening to ensure others views are heard  Ethical theories that are relevant to health care Deontology – consequences are not what matters; actions themselves are examined. They examine a situation for the existence of essential rightness/wrongness

Utilitarianism- believes that right among of action creates greatest number of good for great number of people. Consequences of an action/ decision are what matters. It is often critiqued because it doesn’t include moral integrity Bioethics- NOT A THEORY!!! It is an area of study that focuses on the relation between philosophy and moral philosophy 1) Autonomy – ones right to make choices for oneself based on full understanding & HC professional have to respect it 2) Beneficence- doing good for others; giving the best care possible 3) Non-maleficence- avoid causing harm of hurting the patient in treatment given time 4) Justice- fairness; decisions should be based on who needs something most & not their salary. Decisions must be based on someone’s need alone NEED TO BE ABLE TO ANALYZE AN ETHICAL SITUATION IN HEALTH CARE & KNOW HOW VALUES CAN INFLUENCE NURSING CARE: Resolving dilemma requires deliberate, critical and systematic thinking. It mostly required negotiation of differences incorporation of conflicting ideas & requires an effort to respect the differing opinions. Needs to be knowledgeable & adopt in making logical, fair & consistent decisions.  Values - Rules that people abide and live by. Values influence nursing in various ways, b/z values change & so do procedures and policies affecting nursing care. When our values are at odds, it is nurse’s duty to be a better advocate for patients & create open dialogue between nurse and their patient (via open-ended questions).  Ethical dilemma - Conflict between 2 sets of human values, both of which are deemed good, but neither can be fully served. It is an uncertainty. - Ethical service/committee review morally troubles cases to help in decision making  Resolving an ethical dilemma - In a committee setting, at client bedside or in a family conference - Nurse must apply careful critical reflection on dilemma. Process of negotiation of ethical dilemmas may be in part, the process of understanding ambiguity. Nurse needs to be knowledgeable and adapt in making good logical, fair and consistent decision - There are 7 steps to resolving ethical dilemma: I. Is it an ethical dilemma? II. Gather relevant information III. Examine your own values IV. Evaluate the action V. Verbalize the problem VI. Consider possible options VII. Negotiate the outcome

BE FAMILIAR HOW THEY ETHICAL DILEMMAS ARISE (ADVANCES IN TECHNOLOGY, END-OF-LIFE EXPERIENCES, & CHANGES IN WORK ENVIRONMENT) Legalities 

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Negligence - No intentions in hurting; - Characteristics of inadvertence - Thoughtlessness and inattention Confidentiality - Obligation to not to divulge anything said - Only tell when there’s a harm, court order or child abuse Informed consent - Patients agreement to allow medical action on fully understanding - It is physicians duty to explain and nurses duty to ensure it is understood by patient Litigation - Law suit in extreme case of negligence  Legal concepts that apply to nursing Tort- civil wrong that’s made Intentional - Assault- physical/ verbal threat - Battery- intentional physical contact - False imprisonment - Invasion of privacy

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Unintentional - Negligence - Med error - Leaving out information

Living will -Document in which a person makes an anticipatory refusal of life-prolonged measures during a future state of mental incompetence

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Advance directive - Mechanism enabling mentally competent person to plan for a time when he/she may lack the mental capacity to make treatment decisions a) Instructive directive- living will that patient desires b) Proxy directive – by power of attorney person speaks for the ill client SOURCES FOR STANDARDS OF CARE COME FROM HOSPITAL POLICIES (BASED ON POTTER & PERRY CLINICAL NURSING SKILLS), STANDARDS OF PRACTICE & CNA CODE OF ETHICS

 Nurses responsibility

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Nurses have a duty to report, meaning they must take action (whistleblowing) when a nurse is incompetent. It is a legal requirement of them to do so. Failure to do so might cause them to be disciplined VIA Alternative Dispute Mechanism, which gives RNs a chance to heal themselves, and it may go without disciple.

 Nurses obligations - Provide safe and respectful care – Know strengths and weaknesses - Do not discriminate – Be aware of self and admit if you can’t do it  Whether or not a criminal is innocent or guilty, not our concern; nurses are there to heal. - Assure privacy and confidentiality - Safeguard the public – Can do this by being competent and recognizing limitations and incompetency’s; seek help if you are unsure. - Support the good of the profession – Be proactive through the workplace - Support the hospital policies – Only cross them if something isn’t right; advocate for change to occur. - Act in accord with one's own morals – Don’t impose your beliefs onto others, and expect the same from patients within reason. The legal aspects of nurse-client relationship are: The nurse must ensure that the patient understands the consent forms before signing it. If the patient does not fully understand, they must bring back the physician to further explain any uncertainties. - The nurse must not be negligent to their patient’s needs, that is, to fall below their standards of care. - The nurse is responsible for charting all the patient’s information in a timely manner, in order to prevent accidental overdose. The legal aspects of a nurse-physician relationship are: -

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Nurses are obligated to follow a physician’s orders unless they are believed to be in error, violate hospital policy, or would harm patients. All orders must be assessed, and if deemed incorrect or harmful, physician must be called in to review his orders. If the physician still thinks his orders are correct but the nurse is weary, they must notify their supervisor.

The legal aspects of a nurse-nurse relationship are: -

A nurse has the duty to report the actions of other negligent nurses, or ask them if they are sure of what they are doing to ensure their patient’s safety. They must be able to work collaboratively when one is unsure of something, in order to better treat/tend to their patients.

The legal aspects of a nurse-employer relationship are: -

By accepting a job, the nurse enters into an agreement with their employer. The nurse is expected to perform professional duties completely, adhering to their policies and procedures of the institution.

Nursing process -

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Development of a problem- solving approach to identifying, diagnosing and treating health issues of patients 5 steps: I. Assessing phase – data gathering (subjective- symptoms & objective – signs) II. Analyzing phase – identify a problem and formulate goal Check for: Breathing Activity intolerance Pain Body image disturbance Body temperature, risk for altered III. Planning phase – creation of plan care for the issue that’s raised. Writing care plan to meet goals IV. Implementing phase – carry out the plan - Putting nursing care plan in action - Nursing interventions to meet goal or begin working on it V. Evaluating phase – objective data to determine the extend to which goals were achieved, (if not achieved then revise the plan) - Find out if goal is met/ not - Decide to continue or end of plan Nursing diagnosis Diagnosis that nurses are able to write (basically things that they are allowed to do) Ex: not diabetes, but if there’s a cut on patients arm nurses can take care of that

Writing nursing diagnosis [nursing diagnosis is 2nd step of nursing practice] Organize & cluster data Compare data against standards (meaning if nurses are able to continue with this diagnosis or not) - Analyze data after comparing with standards - Determine patients health problem - Formulate nursing diagnosis There are 3 activities in nursing diagnosis: Data Analysis + Problem identification + Formulating Nursing Diagnosis  -

KNOW HOW TO APPLY NURSING PROCESS TO SPECIFIC CLINICAL SITUATIONS Critical thinking- ways of knowing - Skills that lets nurse approach each new problem involving client care with openmindedness, creativity, confidence and wisdom - Develop as years pass by while working in nursing field - 3 types: I. Basic critical thinking – thinking concrete & based on a set of rules or principles II. Complex critical thinking- nurse begins to separate her thinking process from those of authorities and analyze /examine choices independently - Nurse is willing to consider other options in addition to routine procedure III. Commitment critical thinking- nurse makes choices without assistance from other professionals & assumes responsibility/ accountability for those choices Barbara Carper’s ways of knowing: - Empirical – factual knowledge from science - Personal- imagining oneself in patients position, self understanding - Ethical- knowledge derived from ethical framework, awareness of moral questions and choices - Aesthetic- awareness of immediate situation, seated in immediate practical action Critical thinking is important in nursing field, because it is a cognitive process that a nurse uses to make judgments about clinical care of patients Reflection- is a process of purposefully thinking back/recalling situation to discover its purpose/meaning. It is important for self-evaluation and improvement of nursing practice. Reflective journal writing- is a tool for developing critical thoughts and reflection through clarifying concepts. By keeping reflective journal of each of clinical experiences, nurses are able to explore persona perception/understanding of the experience & develop the ability to apply theory in practice.    

Specific critical thinking- diagnostic reasoning, clinical inference and clinical decision making in clinical situation Diagnostic reasoning and interference- process of determining client health status after nurse makes physical and behavioral observations & after nurse assigns meaning to behaviors Clinical interference- process of drawing conclusion form related pieces of evidence Clinical decision making – problem solving activity that focuses on defining client problems and selecting appropriate treatments

Nursing theory

It is a purposeful set of assumptions or propositions about concepts Shows relationships between concepts and thereby provides a systematic view of phenomena so that they may be explained, predicted or prescribed - It is basically a set of concepts, definitions, relationships and assumptions that project a systematic view of phenomena Nursing theory is useful because they provide guideline to nursing practice and they help to explain, predict and prescribe phenomena Nursing theory also guides nursing practice & generated knowledge. Theory helps to describe or explain nursing. It enables nurses to know WHY they are doing WHAT they are doing -

Caring -

Caring is central to nursing and is a concept that is key to nursing practice Its characteristics are being compassionate, having mechanical voice and mechanical touching

Nurses demonstrate caring by: - Being present in physical and mental contents - Offering support, body language and listening - Getting to know their patient, don’t make assumptions - Caring touch - Listening in each encounter with client Barriers of caring: - Demands - Pressure - Time constraints in health care environment

They all leave little room for caring practice

How do nurses demonstrate care to profession? - By being supportive colleague - By following professional standards and code of ethics Culture -

Broadly shared patterns of learning values and behaviors that are transmitted over time that distinguish the members of one group from another Can be: language, ethnicity, gender, age, spiritual belief, religious belief, group history, geographic origin, socioeconomic class, sex orientation, education, childhood/life experience Subculture- group of people, members of culture groups, but have certain ethic, occupational or physical characteristics, not common to larger culture Domain group- group that has most authority to control values and sanctions

Minority group- have physical/cultural characteristics that identify them as “different” Cultural assimilations- minority person looses his/her cultural characteristics by living in dominant group Stereotyping- assumptions that all members of culture, subculture or ethnic group act in same manner Cultural imposition- belief that everyone should conform to the belief system of the majority Ethnocentrism- belief that ones belief/idea/practice is best or most preferred to others. Providing culturally competent nursing care meanings that care is planned and implemented in a way that is sensitive to the needs of the individuals, families and groups from diverse cultural populations within our society. Nurses need to be bread minded and culturally sensitive in relation to the effects of global health issues on nursing practices. Nurses need to recognize that they are differences among groups and individuals. Nurses should not extend a stereotype or generalize common characteristics of a group to all members associated with that group. Nursing research -

A way to identify new knowledge, improve professional education and practice and use resources effectively It is a systematic examination of phenomena that’s important to nursing discipline, as well as to nurses, their clients and families It addresses a range of issues related to actual and potential client populations & to individual, family responses to health problems.

Types of nursing research:  Quantitative research- investigation of nursing phenomena that can be precisely measured and quantified - Experimental research- focuses on why one variable causes a predictable change in another variable - Quasi-experimental research- where groups are forms and conditions are controlled, but the subjects are not randomly assigned to a control group or to treatment conditions - Descriptive-survey research- designed to answer questions about relationships among variables - Exploratory descriptive designs research - provides in-depth descriptions of population or variables not previously studied. Usually starts by questioning “WHAT” - Data analysis research - outcome is verbally describes, all quantitative studies entail the use of statistical analysis  Qualitative nursing research- poses questions about nursing phenomena that cant be quantified and measured

- Ethnography research - observation and description of behavior in social settings. Ex: used to study the behaviors of nurses and their clients in a variety of settings - Phenomenology research - focuses on the lived experience of a specific phenomenon from the perspective of the people who are in the situation. Ex: researcher must learn to understand a phenomenon from the viewpoint of people experiencing it. - Grounded theory research - research method as a mean of generating hypothesis and theories about social processes inductively from the data. It is usually “discovered”, dev...