NUR2058 Dimensions of Nursing Practice Practice Exam 1 Study Guide PDF

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Exam 1 Study Guide
Chapter 1
• Define evidence-based practice: The selective and practical use of the best evidence, as
demonstrated by research, to guide health-care implementation and decisions (found
under terms)
• Review difference between roles: (pg. 4)
o Pos...

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Exam 1 Study Guide Chapter 1 •

Define evidence-based practice: The selective and practical use of the best evidence, as demonstrated by research, to guide health-care implementation and decisions (found under terms)

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Review difference between roles: (pg. 4) o Position: A group of tasks assigned to one individual o Job: A group of positions similar in nature and level of skill that can be carried out by one or more individuals o Occupation: A group of jobs similar in type of work that are usually found throughout an industry or work environment o Profession: A type of occupation that requires prolonged preparation and formal qualifications and meets certain higher level criteria that raise it to a level above that of an occupation o Professional: A person who belongs to and practices a profession (The term professional is probably the most misused of all these terms when describing people who are clearly involved in jobs or occupations, such as a “professional truck driver,” “professional football player,” or even “professional thief.”) o Professionalism: The demonstration of high-level personal, ethical, and skill characteristics of a member of a profession

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Identify the traits that define a profession: (pg. 4 & 5) o Process approach: The process approach views all occupations as points of development into a profession situated along a continuum ranging from position to profession.

Using this approach, the question becomes not whether nursing and truck driving are professions but where they are located along the continuum o Power approach: The power approach uses two criteria to define a profession: 1) How much independence of practice does this occupation have? And 2) How much power does this occupation control? Using this determinant, law and politics would clearly be considered professions. o Trait approach: 3 theorists (Abraham Flexner, Elizabeth Bixler, and Eliza Pabalko) are most widely accepted researches when it comes to identifying traits that define a profession. They determined these characteristics to be important: ▪

High intellectual level

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High level of individual responsibility and accountability

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Specialized body of knowledge

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Knowledge that can be learned in institutions of higher education

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Public service and altruistic activities

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Public service valued over financial gain

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Relatively high degree of autonomy and independence of practice

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Need for a well-organized and strong organization representing the members of the profession and controlling the quality of practice

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A code of ethics that guides members of the profession in their practice

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Strong professional identity and commitment to the development of the profession

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Demonstration of professional competency and possession of a legally recognized license

Review how nursing compares with other professions: (pg. 5 & 6) o High Intellectual Level: as health care has advanced and made great strides in technology, pharmacology, and all branches of the physical sciences, a high level of intellectual functioning is required for even relatively simple nursing tasks, such as taking a client's temperature or blood pressure using automated equipment. On a daily basis, nurses use assessment skills and knowledge, have the ability to reason, and make routine judgments based on clients’ conditions. Without a doubt, professional nurses must function at a high intellectual level. o High Level of Individual Responsibility and Accountability: Nurses are often the primary, and frequently the only, defendants named when errors are made that result in injury to the client. Nurses must be accountable and demonstrate a high level of individual responsibility for the care and services they provide o Specialized Body of Knowledge: As the body of specialized nursing knowledge continues to grow, it forms a theoretical basis for the best practices movement in nursing today. As more nurses obtain advanced degrees, conduct research, and develop philosophies and theories about nursing, this body of knowledge will increase in scope and quantity. o Evidence-Based Practice: In professional nursing today, there is an increasing emphasis on evidence-based practice. Almost all of the currently used nursing theories address this issue in some way

o Public Service and Altruistic Activities: The public service function of nursing has always been recognized and acknowledged by society's willingness to continue to educate nurses in public, tax-supported institutions and in private schools. In addition, nursing has been viewed universally as an altruistic profession composed of selfless individuals who place the lives and well-being of their clients above their personal safety. •

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Review how students should use recourses like websites, journals (pg. 7 & 8): o Peer Review: When considering a Web source, look for a clear statement of the source of the information and how that information is reviewed. If the information is from an established source, such as a recognized professional journal, it has been peer reviewed and has a higher degree of accuracy. o Author Credentials: The name of the author and his or her titles and credentials should be listed. Be cautious if no author or publisher is listed. You can also look at the last three letters in the website address. The ones that end in .gov, .org, or .edu tend to have higher-quality information. Also, see whether the information has a copyright. If the information is copyrighted, the person felt strongly enough about what he or she was posting to go to the effort of making sure that no one else could use it as their original information. o Prejudice and Bias: Although there is almost always a small degree of prejudice and bias in all written material, most legitimate authors strive to be as objective as possible. See if contact information is provided by the author and who the sponsor or publisher of the document is. If these are not provided, be suspicious about the information. o Timeliness: See if you can determine when the site was last updated and how extensively the information was revised. It is also a good practice to look to other sources (e.g., Web, journals, books) to compare the material for currentness. o Presentation: Some websites look well developed and professional, and others look very amateurish. There is no guarantee that the slick-looking websites are better, but it is one factor to consider in the overall evaluation of the information you are seeking. Review Nurses’ Code of Ethics (pg. 8): The current 2014 ANA Code of Ethics, while maintaining the integrity found in earlier versions, is now more relevant to current healthcare and nursing practices. This code of ethics is recognized by other professions as a standard with which others are compared. Do nurses have autonomy and independence of practice? Why or why not (pg. 9): Unfortunately, despite efforts to expand nursing practice into more independent areas through updated nurse practice legislation, nursing retains much of its subservient image. In reality, nursing is both an independent and interdependent discipline. Nurses in all health-care settings must work closely with physicians, hospital administrators, pharmacists, and other groups in the provision of care. Determine the main method in which nurses can gain power in nursing (pg. 16): Probably the first, and certainly the most important, way in which nurses can gain power in all areas is through professional unity. According to the ANA, there are approximately 2.7 million nurses in the United States. It is not difficult to imagine the power that the

ANA could have to influence legislators and legislation if all of those nurses were members of the organization rather than the 250,000 who actually do belong. Chapter 2 • Compare healthcare of ancient civilizations to healthcare today. What have the focus, influences, and interventions changed? (pg. 21) Health care was closely related to religious practices in ancient civilizations (#14 on exam questions) • Understand the influence of Hippocrates. How did he change medicine? How are his teachings relevant today? (pg. 21 & 22): Know as the father of medicine. His beliefs focused on harmony with the natural law instead of on appeasing the gods. He emphasized treating the whole client—mind, body, spirit, and environment— (#46 on exam questions) and making diagnoses on the basis of symptoms rather than on an isolated idea of a disease. He was also concerned with ethical standards for physicians, expressed in the now-famous Hippocratic Oath. • Understand the influences of nursing through the centuries: o Religion (pg. 23): In the nation-states that broke away from the Catholic Church, such as England, Germany, and the Netherlands, health care soon degenerated to a condition even worse than that of the Middle Ages. The role of women was reduced under Protestant leadership, and the male nurse all but disappeared. Secular nursing orders gradually took over the duties of the many substandard hospitals that had been established in metropolitan areas. These orders were the first to establish a nursing hierarchy. Primary nurses were called sisters, and those assisting them were called helpers and watchers o Science (pg. 24 & 25): Technological developments in the 19th century included medications such as morphine and codeine for pain and quinine to treat malaria. The arrival of 30 million immigrants in this century meant that the need for health care increased accordingly. Hospitals sprang up, and many instituted their own schools of nursing. After WWI, a segment of the nursing profession began to focus on improving the educational standards of nursing care. The advancements in health care made during World War II required that nurses receive more highly specialized education to meet clients’ unique needs. After the war, many nurses left the profession to raise families, and the spaces were filled by graduates of new programs that trained licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) in just 1 year. At this time, the concept of team nursing came to be widely accepted, although it removed the registered nurses (RNs) from direct client care, requiring them to serve as team leaders. o War (pg. 24 & 25): During the Revolutionary War, there was no organized medical or nursing corps, but small groups of untrained volunteers cared for the wounded and sick in their homes or in churches or barns. In 1751, Benjamin Franklin founded Pennsylvania Hospital, the first U.S. hospital dedicated to treating the sick. Health care increased markedly between the Revolutionary and Civil Wars. Despite the increase in the number of hospitals, most nursing care was still given at home by the family members. Hospitals were considered the last resort with high mortality rates. The Civil War caused more death and injury than

any war in the history of the United States, and the demand for nurses increased dramatically. Women volunteers (as many as 6000 for the North and 1000 for the South) began to follow the armies to the battlefields to provide basic nursing care, although many of them were untrained. Navy Nurses, the American Red Cross, and the Army Nurse Corps all date from this period. Large numbers of women came out of their homes to work in the hospitals, and a number of African American volunteers in the North paved the way for others to enter the healthcare field in the future. Nursing and nurses still had a very negative image prior to the beginning of World War I. Their primary duties were to carry out the orders of physicians, clean, cook, and empty bedpans. However, in the face of the large numbers of injured produced in World War I, nurses’ roles rapidly expanded and they began to be recognized for their skills in providing care and saving lives. o Industrialization (pg. 24): The Industrial Revolution (1760–1840) caused a flood of people throughout Europe to move from rural areas into cities, and cramped living situations caused very bad health conditions and the spread of disease and plagues. Factory owners supported some forms of health care to keep their workers on the job, and this led to an early form of community health nursing. The Sisters of Charity expanded their care to include home care. Only a few male nursing orders survived the Protestant Reformation and Industrial Revolution. Several non-Catholic nursing orders were founded, including the one by the famous Quaker, Elizabeth Fry, who established the Society of Protestant Sisters of Charity in London in 1840, which provided training to nurses who cared for the sick and poor, including prisoners and children. •

Review the symbols of nursing and what they stood for: o Lamp (pg. 26 & 27): The lamp was first introduced as a symbol for the nursing profession at the time of Florence Nightingale. As Nightingale and her nurses made their night rounds, caring for the wounded in unlit wards, they carried oil lamps to light the way. For the wounded and suffering, these lamps became signs of caring, comfort, and often the difference between life and death. for graduate nurses, the lamp, or its close cousin the candle, retains its significance as a symbol of the ideals and selfless devotion of Florence Nightingale. It also signifies the knowledge and learning that the graduates have attained during their years in the nursing program. Even though the nursing graduates may not physically carry an oil lamp during pinning ceremonies, they symbolically carry the brightly burning lamp of their care and devotion as they minister to the sick and injured in their nursing practice. o Cap (pg. 28 & 29): Time of Florence Nightingale cap signified nurse’s devotion to service to others (#23 on exam questions) The traditional garb of nuns, the long-robed habit with the wimple or veil, can be considered the first official nurse's uniform. Each religious order had its own unique style of habit and wimple. The order the nun belonged to could be easily identified from the habit or veil she was wearing. As the Industrial Revolution progressed and the concept of

the modern hospital developed, the care of the sick moved away from religious orders to care by laypeople who did not wear the nun's robe and veil. By the time Florence Nightingale trained at the Institute of Protestant Deaconesses in Germany, the veil had evolved into a white cap that signified “service to others.” However, Florence Nightingale lived and practiced nursing during the Victorian era, which required “proper” women to keep their heads covered. The nursing cap Florence Nightingale wore was similar to the head garb worn by cleaning ladies of the day. It was hood shaped with a ruffle around the face and tied under the chin. This early cap served multiple purposes. It met the requirements of the times for women to keep their heads covered; it kept the nurse's long hair, which was fashionable during the Victorian era, up and off her face; and it kept the hair from becoming soiled. As the number of nursing schools increased, there was a corresponding increase in the need for unique caps. Each nursing school designed its own cap. During nursing school, the cap was also used as a sign of rank and status. As shorter hair became an acceptable style for women in the 20th century, the nursing cap lost its function of controlling long hair. However, it continued as a status symbol and a source of pride and identity for the graduates of nursing schools into the 1970s. As technology increased in the health-care work environment, the traditional nursing cap became more of an obstacle for nurses in the practice setting. Also, research demonstrated that the cap, rather than protecting clients from infection by organisms from the nurse's hair, actually helped to colonize organisms. By the 1980s, health-care facilities no longer required nurses to wear caps as part of the uniform, and nursing schools eliminated the cap as a mandatory item of students’ uniforms. The nursing cap is a reminder of the unchanging values of wisdom, faith, honesty, trust, and dedication. These values are as important in today's modern, technology-filled hospitals as they were in the era when washing floors was a required basic nursing skill.

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o Pin (pg. 27): The first modern nursing pin is attributed to Florence Nightingale. After receiving the medal of the Red Cross of St. George from Queen Victoria for her selfless service to the injured and dying in the Crimean War, Nightingale chose to extend the honor she had received to her most outstanding graduate nurses by awarding each of them a “badge of excellence.” The badge or pin she designed for her school is a deep-blue Maltese cross. In the center of the cross is a relief image of Nightingale's head. As the number of nursing schools increased, each program designed a unique pin to represent its own particular values, philosophies, beliefs, and goals. Review the following individuals for their history and contribution to nursing: o Nightingale (pg. 30): Universally regarded as the founder of modern nursing, Florence Nightingale dedicated her long life to improving health care and nursing standards. When the Crimean War broke out in 1851, she obtained permission to take a group of 37 volunteer nurses into the battlefield area. The war experience strengthened Nightingale's convictions that nursing education required major

reform. Believing that nursing schools should be run by nurses and be independent of hospitals and physicians, she advocated a program of at least 1 year that included basic biological science, techniques to improve nursing care, and supervised practice. She regarded nursing as a lifelong endeavor and felt that nurses should be in direct contact with clients rather than doing menial jobs such as cooking and cleaning. She worked tirelessly for the reform of health care and nursing and was appointed to many related committees and commissions. A prolific writer, she wrote extensively about improving hospital conditions, sanitation, nursing education, and health care in general. She opened her famous Florence Nightingale School of Nursing and Midwifery in 1860 and began to train nurses, who were in great demand throughout Europe and the US. She taught that each person should be treated as an individual and that nurses should meet the needs of clients, no the demands of physicians. o Robb (pg. 32): Robb was focused on the academic rather than the clinical side of nursing and believed that nurses needed a solid theoretical education, a belief that was not well accepted by the medical community at the time. She was director of the Illinois Training School for Nurses, a school that was unique for its time that it was university based and emphasized academic learning. Some of her unique ideas for the time were to develop and implement a grading policy for nursing students that required nurses to prove their abilities in order to be awarded a diploma. She brought together leaders from key nursing schools to form the American Society of Superintendents of Training Schools for Nurses, and she served as chairwoman. The group was the precursor to the National League for Nursing, which was dedicated to improving the standards for nursing education. In 1896, Hampton Robb became the first president of a group for staff nurses in active practice called the Nurses Associated Alumnae of the United States and Canada, which would later become the American Nurses Association (ANA), dedicated to the improvement of clinical practice. She later helped develop the American Journal of Nursing, the first professional journal dedicated to the improvement of nursing, which is still the official journal of the ANA. o Ford (pg. 33 & 34): Credited with founding nurse practitioner (NP) practice. Ford believed that the nurse practitioner philosophy should be to provide a holistic approach to the...