NURS1420U Exam Notes PDF

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Development of Self as Nurse I exam notes review...

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MODULE 1: Nursing Praxis: values, guided actions, art, artistry, and the active care that in the moment integrates knowing (ontology), being (epistemology), amd doing (actions with consequences) as one artiful act – basically who we are as a nurse, what knowledge we have, and the actions that we take in a caring and scientific manner Eupraxis: good praxis Dyspraxis: bad praxis Watson’s Human Caring Theory: Ten Caritas Processes: 1. Sustaining Humanistic-altruistic Values by Practice of loving-kindness, compassion, and equanimity with self/other 2. Being authentically present enabling faith/hope/belief system; honouring subjective inner, life-world of self/other 3. Being sensitive to self and others by cultivating own spiritual practices; beyond ego to transpersonal presence 4. Developing and sustaining loving, trusting-caring relationships 5. Allowing for expression of positive and negative feelings – authentically listening to another person's story 6. Creatively problem solving – “solution-seeking” through caring processes; full use of self and artistry of caring-healing practices vis use of all ways of Knowing/Being/Doing/Becoming 7. Engaging in transpersonal teaching and learning within the context of a caring relationship; staying within other’s frame of reference-shift toward coaching model of expanded health/wellness 8. Creating a healing environment at all levels, subtle environment for energetic, authentic caring presence 9. Reverentially assisting with basic needs as sacred acts; touching mindbodyspirit of other; sustaining human dignity 10. Opening to the spiritual, mystery, unknowns–allowing for miracles Watson’s Caritas-Veritas Literacy & Caring Processes captured in one simple word: 1. Embrace (loving-kindness) ○ Embracing love and kindness towards ourselves and others 2. Inspire (faith-hope) ○ Being truly there authentically present with the patient which will provide them with the faith and hope to enable the belief system that they honour ○ Understanding the patient’s needs 3. Trust (transpersonal self) ○ Sensitivity towards oneself and others, trusting yourself will allow others to trust you 4. Nurture (relationship) ○ Developing and sustaining the loving, inspiring, trusting relationship with our patients 5. Forgive (all) ○ Allow the expression for positive and negative feelings, authentically listen to other stories, being non-judgmental and showing acceptance 6. Deepen (creative self) ○ Deepen your knowledge of caring through reflection and caritas processes

7. Balance (learning) ○ Engage in personal learning and teaching, authentically listen, appreciate inner learning and wisdom 8. Co-create (caritas field) ○ Create a healing environment at all levels (creating a comfortable and clean environment) 9. Minister (humanity) ○ Everything we do to help our patients are sacred acts, they are a gift, we are ministering sacred acts 10. Open (infinity) ○ Open to spirituality, the belief in miracles Professional Nursing Organizations: (CNA & CNO) - Nursing education (CNO) - Registration and licensure (CNO) - Certifications (CNA) - Professional organizations - Only RPN, RN, NP are allowed to use the title nurse in Ontario - Unions (CNA) - Standards of practice (CNO) - Ethical standards of practice (CNO) - Code of Ethics (CNA) - Code of conduct (CNO) CNA: covers all of Canada, all the provinces and territories CNO: regulates nurses in Ontario only CNO Fact Sheet - About the College of Nurses: https://www.cno.org/globalassets/docs/general/45002_spectrumservice.pdf - Its mission is regulating nursing in the public interest - Only individuals with a valid certificate of registration and current College membership are legally entitled to practise nursing in Ontario and use the protected titles “nurse,” “Registered Nurse” (RN), “Registered Practical Nurse” (RPN) and/or “Nurse Practitioner” (NP) - The Regulated Health Professions Act, 1991 and the Nursing Act, 1991 provide the legislative framework for regulating nursing in Ontario - Their governing Council is composed of nurses elected by their peers and members of the public appointed by the provincial government Four regulatory functions of the CNO: 1. Articulating and promoting practice standards 2. Establishing requirements for entry to practice 3. Administering a Quality Assurance Program 4. Enforcing standards of practice and conduct Five statutory Committees of the CNO: 1. Discipline Committee: holds hearings in cases in which a member of the College has been referred by Inquiries, Complaints and Reports Committee because of the serious nature of alleged professional misconduct

2. Fitness to Practise Committee: determines whether a nurse is suffering from a physical or mental condition or disorder that is affecting, or could affect, her or his practice, and if so what action may be necessary to protect the public 3. Inquiries, Complaints and Reports Committee: screens matters related to public complaints or information the College receives through reports and determines whether a hearing is required or if some other action would address the public interest 4. Quality Assurance Committee: responsible for ensuring that members comply with all aspects of the QA Program 5. Registration Committee: determines whether applicants are qualified to practise nursing in ONtario or if further actions are needed to meet registration requirements CNO Entry to Practice Competencies: https://www.cno.org/globalassets/docs/reg/41037-entry-to-practice-competencies-2020.pdf There is a total of 101 competencies organized thematically under nine roles: 1. Clinician: provide safe, competent, ethical, compassionate, and evidence-informed care across the lifespan in response to client needs; integrate knowledge, skills, judgement and professional values from nursing and other diverse sources into their practice (27) 2. Professional: professionals who are committed to the health and well-being of clients; uphold the profession’s practice standards and ethics and are accountable to the public and the profession (14) 3. Communicator: communicators who use a variety of strategies and relevant technologies to create and maintain professional relationships, share information, and foster therapeutic environments (8) 4. Collaborator: collaborators who play an integral role in the health care team partnership (5) 5. Coordinator: coordinate point-of-care health service delivery with clients, the health care team, and other sectors to ensure continuous, safe care (9) 6. Leader: leaders who influence and inspire others to achieve optimal health outcomes for all (11) 7. Advocate: advocates who support clients to voice their needs to achieve optimal health outcomes; also support clients who cannot advocate for themselves (14) 8. Educator: educators who identify learning needs with clients and apply a broad range of educational strategies towards achieving optimal health outcomes (5) 9. Scholar: scholars who demonstrate a lifelong commitment to excellence in practice through critical inquiry, continuous learning, application of evidence to practice, and support of research activities (8)

MODULE 2: Relational Practice: Nurses must be able to: - Take initiative - Be authentic and responsive - Reach out and listen - Be spontaneous and genuine - Have mutuality Watson’s Characteristics of Caring: - Mutuality - Feelings that are felt and expressed by each person with the same feeling of relationship so there’s mutuality between two people contributing to and shaping the situation - Intentionality - Deliberately done with intention which involves thoughts, beliefs and decisions; with intentionality there’s a purpose and focus. What is the point here in the relationship? - Knowing - Refers to the ways of knowing - each person’s personal understanding of what caring is and how they know or knew the other person was ready to receive the caring varies - Attunement - Adjusting oneself to something and become responsive and recipient to the other person to support them and to do something to attune to the situation - when they are ready to receive caring - Transformation - The transformation for both the patient and the nurse happen at the same time Swanson’s Theory of Caring: Knowing: striving to understand an event as it has meaning in the life of another person - Avoiding assumptions about the life of the other person - Centring on the one cared for - Seeking cues Being with: being emotionally present for the other person - Engaging the self or both the self and the other person - Being there - Conveying ability - Sharing feelings Doing for: doing for (assisting) the other person with actions that he or she would do for himself or herself if it were at all possible - Not burdening - Comforting - Anticipating - Performing skillfully - Protecting

Enabling: facilitating the other person’s passage through life transitions (e.g. birth, feath) and unfamiliar events - Preserving dignity - Informing and explaining - Supporting and allowing - Focusing - Generating alternatives Maintaining belief: sustaining faith in the other person’s capacity to get through an event or transition and face a future with meaning - Validating and giving feedback - Believing in and holding in esteem - Maintaining a hope-filled attitude - Offering realistic optimism - Spending extra effort to help the other person CNO Practice Standard: Therapeutic Nurse-Client Relationship https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf CNO Therapeutic Nurse-Client Relationship Learning Modules: Six guiding principles: 1. Nursing is one profession with two categories (RNs and RPNs) 2. The foundational knowledge base for RNs and RPNs is different (differences in education) 3. Nurses enhance their knowledge through education, experience and reflection 4. Nurses are accountable for their actions 5. Clients are the central focus of nursing care 6. The overall goal is the best possible client outcome Five key components: 1. Professional intimacy ○ Is inherent in the type of care and services that nurses provide ○ May involve psychological, spiritual and social elements 2. Power ○ A relationship of unequal power, the nurse always has more power ○ If a nurse misuses this power it’s considered abuse 3. Empathy ○ Understanding from the client’s perspective ○ Includes validating and resonating with their experience and maintaining an appropriate emotional distance from the client to ensure objectivity 4. Respect ○ The recognition of the inherent dignity, worth, and uniqueness of every individual regardless of the client’s socioeconomic status, personal attributes and the nature of the client’s health problem 5. Trust ○ Critical in the nurse-client relationship as the client is vulnerable ○ Fragile especially in the beginning so it’s important to keep promises to a client ○ Difficult to reestablish once breached Four standard statements:

1. Therapeutic communication: Nurses use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-client relationship. Nurses achieve therapeutic communication by: ○ Introducing themselves to clients by name and designation ○ Giving clients an opportunity to express themselves without diminishing them and before immediately giving out advice ○ Telling clients that information will be shared with the health care team ○ Being aware of their verbal and non-verbal communication style ○ Modifying their communication as necessary ○ Recognizing that all behaviour has meaning (ex. Client refuses to eat) ○ Respecting the client’s beliefs and values ○ Integrating the client’s beliefs and values into the plan of care ○ Engaging the client in how the client will meet care needs after the termination of the relationship 2. Client-centred care: nurses work with the client to ensure that all professional behaviours and actions meet the therapeutic needs of the client. Nurses achieve client-centred care by: ○ Actively including the client and significant others in the care ○ Identifying the client’s goals, wishes and preferences ○ Recognizing that the client’s well-being is affected by the nurse’s ability to establish and maintain a therapeutic relationship ○ Acknowledging that biases and feelings can affect the relationship ○ Requesting to transfer care when the relationship is not evolving therapeutically 3. Maintaining boundaries: nurses are responsible for effectively establishing and maintaining the limits or boundaries in the therapeutic nurse-client relationship. Nurses maintain boundaries by: ○ Developing a plan of care with the client that aims to meet the client’s needs ○ Following the plan of care ○ Recognizing that certain practice settings require increased vigilance to maintain boundaries ○ Not accepting a gift from a client unless the refusal will harm the nurse-client relationship ○ *if refusing a gift would harm the therapeutic relationship: i. Consult with a manager and document the consultation ii. Ensure that the gift wasn’t solicited iii. Clarify the client’s intent in offering the gift iv. Assess the appropriateness of the timing v. Consider the monetary value of the gift Warning signs of crossing a boundary: ○ Spending extra time with one client more than the others ○ Changing client assignments to give care to the client ○ Telling the client personal information that does not contribute to the therapeutic relationship ○ Dressing differently when seeing a specific client ○ Frequently thinking about the client ○ Spending off-duty time with the client

○ Ignoring agency policies when working with the client 4. Protecting the client from abuse: nurses protect the client from harm by ensuring that abuse is prevented, or stopped and reported. 5 types of abusive behaviours: ○ Financial ○ Verbal and emotional ○ Physical ○ Sexual ○ Neglect

MODULE 3: CNO Practice Standard Privacy & Confidentiality: https://www.cno.org/globalassets/docs/prac/41069_privacy.pdf Personal Health Information Protection Act, 2004 (PHIPA) - Governs health care information privacy in Ontario - Requires that personal health information be kept confidential and secure Quality of Care Information Protection Act, 2016 (QCIPA) - Provides broad protection to quality of care information produced by a health care facility - Its purpose is to promote open discussion of adverse events, peer review activities and quality of care information while protecting this information from being used in litigation or accessed by clients Personal health information: Any identifying information about clients that is in verbal, written or electronic form. Clients do not have to be named for information to be considered personal health information. Some examples include: - Physical or mental health information - Care provided - Plan of service - Payments or eligibility for health care - Donation of body parts or substances (e.g. blood donations) - A person’s health number - The name of a client’s substitute decision maker Implied consent PHIPA specifies that several conditions must be met to assume a client’s implied consent. It is a custodian’s obligation to fulfil these conditions by posting a notice or providing a brochure that describes the purposes for the collection, use and disclosure of personal health information Express consent PHIPA does not require a specific form of express consent, which may be given verbally or in written form. Express consent is required in the following situations: - Personal health information is to be disclosed outside of the health care team - Information is to be disclosed (within the health care team) for purposes other than providing or helping to provide care - Personal health information is used for fundraising - Personal information is being collected for marketing research or marketing activities Substitute decision-makers If a client cannot provide consent, then a substitute decision-maker may make decisions and provide health information CNO Professional Misconduct: https://www.cno.org/globalassets/docs/ih/42007_misconduct.pdf Under the authority of the Regulated Health Professions Act, 1991 (RHPA) and the Nursing Act, 1991, the CNO regulates the practice of nursing to protect the public interest. - Failure to maintain the standards of practice - Working while impaired - Theft

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Failure to obtain informed consent and breach of confidentiality Inadequate documentation and record keeping Failure to meet legal/professional obligations Conflict of interest Inappropriate business practices Other grounds for professional misconduct: guilty of an offence, sexual abuse

CNO Practice Guideline - Consent: https://www.cno.org/globalassets/docs/policy/41020_consent.pdf Follows the Health Care Consent Act, 1996 (HCCA) and the Substitute Decisions Act, 1992 (SDA) Health Care Consent Act, 1996 (HCCA) - Deals with the client’s capacity to make decisions in relation to specific treatment Substitute Decisions Act, 1992 (SDA) - Deals with decision-making about personal care or property on behalf of incapable persons - Involves the formal appointment of a decision-maker through a power of attorney document, through the Office of the Public Guardian and Trustee (PGT) or through a court appointment - Only trained capacity assessors may determine capacity for the purpose of the SDA - A power of attorney for personal care comes into effect when the person who granted it becomes mentally incapable unless it states otherwise - Substitute decision-maker: a person identified by the HCCA who may make a treatment decision for someone who is incapable of making his/her own decision - Hierarchy of substitute decision-makers: ● Guardian of the person ● Attorney for personal care ● Someone appointed as a representative by the CCB (Consent and Capacity Board) ● Spouse/partner ● Child if 16 or older ● Parent who has only a right of access ● Brother or sister ● Other relative ● PGT is the substitute decision-maker of last resort in the absence of any more highly ranked substitute, or in the event two more equally ranked substitutes cannot agree

MODULE 4: Therapeutic Communication techniques: - Active listening - Sharing observations, empathy, hope, humour, feelings - Using touch, silence - Providing information - Clarifying - Focusing - Paraphrasing - Asking relevant questions (open-ended questions) - Summarizing - Self-disclosure Non-therapeutic communication techniques: - Asking personal questions to satisfy your own curiosity ● Ex. “Why don’t you and John get married?” - Giving personal opinions ● Ex. “if I were you I’d put your mother in a long-term care facility” - Changing the subject ● Ex. “Let's not talk about your problems with your job. It’s time for your walk” - Automatic responses (stereotypes/assumptions) ● Ex. “Older persons are always confused” - False reassurance ● Ex. “you’ll be fine” - Sympathy ● Ex. “I’m so sorry about your mastectomy, it must be hard losing a breast” ● Sympathy is a subjective vision, if you over identify with the patient, you will lose objectivity and be unable to effectively help the patient work through his or her situation - Asking for explanations ● Ex. Why are you so anxious? - Approval or disapproval ● Ex. “you shouldn’t even think about assisted suicide, it’s wrong” - Defensive responses ● Ex. “No one here would intentionally lie to you” - Passive or aggressive responses ● Ex. passive responses: “things are bad and I can’t do anything about it” ● Ex. aggressive responses: “things are bad and it’s all your fault” - Arguing ● Ex. “how can you say you didn’t sleep a wink when I heard you snoring all night?”

MODULE 5: Carper’s Ways of Knowing: Personal: use of self - Personal understanding and meaning making, therapeutic use of self focusing on interpersonal processes, reciprocal actualization, knowing self in reflection and relationship is subjective, concrete, existential, and promoting wholeness and engagement Ethics: Moral knowledge - Respecting for human life, what ought to be done, abt philosophical and ethical framework, the capacity to make moral choices Empirical: science of Nursing - Factual, verifiable, reliable, science of illness Aesthetics: art of nursing - The art of discovery, expressive, appreciation and percept...