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Fundamentals of Nursing: Mod 1
Terms in this set (116)
Name the nursing program core values
Critical thinking, caring, holism, safe practice, role development, information management and technology
Define critical thinking
An active organized cognitive process used to examine one's thinking and the thinking of others. A process that involves using one's mind in framing conclusions, making decisions, drawing inferences and reflecting.
Name the skills involved in the critical thinking process.
Interpretation, analysis, evaluation, inference, exlanation, self regulation.
Define interpretation as it relates to critical thinking
Systematic orderly data collection; look for patterns to categorize data, clarify any data you are uncertain about
Define analysis as it relates to critical thinking
Be open minded as you look at information about the patient; do not make careless assumptions; does data reveal what you believe is true or are there other options.
Define evaluation as it relates to critical thinking
Look at all situations objectively; use criteria (expected outcomes, pain characteristics, learning objectives) to determine results of nursing actions; reflect on your own behavior.
Define inference as it relates to critical thinking
Looking at the meaning and significance of findings; does data about the patient help you see that a problem exists?
Define explanation as it relates to critical thinking
Support your findings and conclusions; use knowledge and experience to choose strategies to use in the care of patients; justify procedures and present arguments.
Define self-regulation as it relates to critical thinking
Reflect on your experiences; identify the ways you can improve your own performance; what will make you believe you have been successful?
A universal phenomenon that influences the ways in which people think, feel and behave in relation to one another.
Benner's statement on caring
Caring means that persons, events, projects and things matter to people; it creates possibility
With what is an ethic of care concerned?
Relationships between people and with a nurses character and attitude towards others.
______________ is at the heart of ability to work with people in ____________&___________ways.
Caring, respectful, therapeutic
How is caring related to culture?
Human caring varies among cultures in its expressions, processes and patterns.
Name the 5 characteristics of Swanson's theory of caring
Knowing, being with, doing for, enabling, maintaining belief
Define knowing according to Swanson
Striving to understand an event as it has meaning in the life of the other; avoiding assumptions; centering on the one cared for; seeking cues; engaging the self or both.
Define being with according to Swanson
Being emotionally present to the other; being there, conveying ability, sharing feelings, not burdening
Define doing for according to Swanson
Doing for the other as he or she would do for self if it were possible; comforting; anticipating; performing skillfully; protecting; preserving dignity
Define enabling according to Swanson
Facilitating the others passage through life transitions (eg. birth, death) and unfamiliar events; informing; explaining; supporting; allowing; focusing; generating alternatives; validating; giving feedback
Define maintaining belief according to Swanson
Sustaining faith in the others capacity to get through an event or transition and face a future with meaning; believing in; holding in esteem; maintaining a hope filled with attitude; offering realistic optimism; going the distance
The whole is greater than the sum of it's parts
Name three domains of holistic nursing
Theory, concept, practice
Holism considers these five aspects of the individual
Physiological, psychological, sociocultural, intellectual, spiritual
Describe holistic nursing care
The art and science of caring for teh whole person, knowing that each individual is unique in all aspects of self.
What are four holistic concepts to keep in mind as a nurse relating to a patient?
Mind and body are one, not separate; people are responsible for their own choices; people have power to solve their own problems; well-being is multifaceted (physical, emotional, mental, spiritual)
Define safe practice as it relates to the core values
Providing safe quality patient care according to the standards of practice
When were the standards of nursing practice first established, by whom and how many standards were there?
1973, ANA Congress, 8
What are the minimum standards of care
Assessment, diagnosis, Outcomes ID, planning, implementation, (coordination of care; health teaching & health promotion; consultation; prescriptive authority & treatment) & evaluation
Define assessment in relation to ANA SoP
The registered nurse collects comprehensive data pertinent to the patients health or situation
Define diagnosis in relation to ANA SoP
The registered nurse analyses the assessment data to determine the diagnosis or issues
Define outcomes ID in relation to ANA SoP
The registered nurse identifies expected outcomes for a plan individualized to the patient or situation
Define planning in relation to ANA SoP
The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes
Define implementation in relation to ANA SoP
The registered nurse implements the identified plan within 4 domains (coordination of care, health teaching and promotion, consultation and prescriptive authority and treatment)
Define evaluation in relation to ANA SoP
The registered nurse evaluates progress toward attainment of outcomes
What was the principle role of the nurse in the past?
Limited scope of practice, provide comfort and care, carry out specific functions.
What is the current and expanded role of the nurse?
Comfort and care, specific functions, health promotion & illness prevention as well as concern for client as a whole
What are the classifications of the progressive roles in the continuum of nursing?
Novice, advanced beginner, competent, proficient, expert.
Define novice nurse
Beginning nursing student or any nurse entering a new field w/o experience
Define advanced beginner nurse
Nurse who has some level of experience with the situation; is able to identify meaningful aspects of principles of nursing care
Define competent nurse
Nurse who has been in the same position for 2-5 years, understands the organization and specific care required; generally has experience with all types of psychomotor skills required by this type of client
Define proficient nurse
> 3 years experience in the same position & perceives client's clinical situation as a whole; is able to asses the entire situation; readily transfers knowledge gained from multiple previous experiences; nurse focuses on managing care as opposed to managing & performing skills
Define expert nurse
Diverse experience intuitive grasp of existing or potential clinical problems; able to zero in on the problem and focus on multiple dimensions of the situation; skilled at identification of client-centered problems related to the health care system or the needs of the novice nurse
Define information management in relation to the core values
Interventions to facilitate communication among health care providers
Avenues for nursing role development
NUR 151, history of nursing, HIPPA, nurse practice act, life long learning, legal and ethical guidelines, client advocacy, evidence based practice, time management, professional image, licensure, involvement in professional organizations
Nightingale's theory (1860)
1859 notes on nursing; provide therapeutic environment (light, sanitation, nutrition, quiet atmosphere, fresh air), providing empathetic care, providing confidential care, providing care through vital assessment, providing care that encourages independence and restoration of health (considerations; holistic, social, cultural, spiritual)
Types of health care delivery systems
Acute care, chronic or sub-acute care, rehab facilities, long term care assisted living, home health, community health, women & children, hospice, state and federal, private. (health care organizations, disease management, case management)
What is the biggest trend shaping health care?
Evidence based practice - EBP is a systematic approach to rational decision making that facilitates achievement of best practices. A step-by-step approach ensures that you obtain the strongest available evidence to apply in patient care.
Name the 6 steps of EBP
1 Ask a clinical question.
2 Collect the most relevant and best evidence.
3 Critically appraise the evidence you gather.
4 Integrate all evidence with one's clinical expertise and patient preferences and values in making a practice decision or change.
5 Evaluate the practice decision or change.
6 Share the outcomes of EBP changes with others.
Other trends in health care
Specialization, advanced practice nurses, advances in technologies, informed clients, holistic care, focus on wellness (promotion and prevention) disease management programs, rising health care costs, ethical issues, shortage of nurses, nurse/hospital being sued.
Basic description of LPN, RN and APN
LPN - 18 mo program / pass NCLEX-LPN,
RN - 24 to 48 month program depending on ASN or BSN / pass NCLEX-RN,
APN - master or beyond, clinical nurse specialist, nurse practitioner (family, OB, peds, geriatrics), nurse educator, nurse anesthetist, midwife
Certifications that RN's can hold
CNE- certified nurse educator,
CCRN - critical care registered nurse,
ONS - oncology nurse specialist,
CRNI - certified registered nurse infusionist,
WOCN - wound ostomy continence nurse, chemotherapy, PICC insertions, epiderals,
OB-Gyn, telemetry, ect...
Educational orientation in nursing
Commit to lifelong learning and career development, nursing organizations, continuing education programs at place of work, seminars, conferences, classes, professional journals, websites, newspaper.
Name nine major rolls in nursing
Caregiver, communicator, teacher, counselor, leader, researcher, advocate, manager of care, member of dicipline
Combines the art of caring and the science of nursing to meet the holistic needs of individuals, families and communities through collaboration with other health professionals.
Uses effective interpersonal and therapeutic communication skills to establish and maintain helping relationships with clients of all ages in a wide variety of health care settings
The nurse educator uses communication skills to assess, plan, implement and evaluate client learning; the nurse shares information formally and informally and acts as a consultant to promote restore and maintain health
Nurses encourage clients to look at alternatives, recognize their choices and develop a sense of control in rapidly changing health care environments
The nurse manager demonstrates an ability to communicate effectively uses critical thinking skills, coordinates cost effective care and provides case management; the nurse manager delegates care, guides and directs others and collaborates with interdisciplinary and intradisciplinary health care teams.
Leadership roles held by staff nurses
Team leaders, charge nurses, role models
The nurse researcher uses and participates in nursing research to increase knowledge in nursing and improve client care.
Promotes human dignity, respects diversity, protects legal rights of client, enhances access to health care, assists clients in making informed decisions regarding health
Define manager of care
Nurse is responsible for assessing client needs; developing a care plan and ensuring that appropriate nursing interventions are delivered to the client; often serves as coordinator between different members of the health care team such as PT, OT & physicians.
Define member of nursing discipline
Professional who is science driven, technically skilled and caring; autonomous, independant in decision making & practice; able to collaborate with other HCP; every nurse is responsible and accountable to ensure patients receive quality care.
Define elder abuse
Harm caused by: physical abuse, neglect, intimidation, cruel punishment, financial abuse, abandonment, deprivation of goods or services necessary to avoid physical harm or mental suffering of an elderly adult
Define passive neglect
Well-intentioned caregiver is incapable of meeting the needs of the elder.
Define active neglect
Malicious, with holding of basic life necessities, can include over or under medicating
Define psychological abuse
Profanity or intimidating verbal conduct
Define financial abuse
Caregiver squanders elders funds or refuses to make expenditures necessary to the patient's health or general well-being
How to protect elders from abuse
Required by AZ law for HCW's to report elder suspected abuse; call 911 if pt is in imminent danger; social workers may visit and assess situation; contact APS, investigates and discusses alternatives w/ pt. and fam. or remove pt. from facility; pt. may refuse to leave abusive situation; documentation is very important.
Helping pts who are victims of domestic violence
4 million persons physically abused each year; 20 million verbally or emotionally abused each year; 95% are women; when HCW knows or suspects abuse, they can refer them to social agencies; (1994) violence against women act provides enforcement of "order of protection."
Dress professionally, always be on time, treat others with respect and dignity, convey calm caring attitude, be sensitive to cultural differences, follow policy and procedure, apply standards of care, ask for help when needed, duty to report, understand employee handbook
Five patient rights of delegation
RN's can delegate; 1. right task 2. right circumstance 3. right person 4. right communication/direction 5. right supervision.
Helps reduce stress; should be goal directed; keep a to-do list; complete one task before starting the next whenever possible; goal setting; time analysis; priority setting; interruption control; evaluation of day.
Scope of practice
SoP is set by the state board of nursing; each RN is responsible for state SoP, agency policies and procedures; do not perform a procedure if you do not feel adequately trained and prepared.
Common areas of conflict management
Quality of care, treatment decisions, family involvement, quality of parental care, staff inconsistency.
Maintain professional relationships with clients and their families; proficient conflict management skills; self care strategies; workers rights - harassment - discrimination - violence.
Conflict management with other health care workers
Common areas of conflict include: failure to communicate effectively; workload division; quality of care; treatment decisions; errors.
10 tips to manage conflict
Deal directly; avoid making it personal; sort out feelings first; use "I" statements; ask for input (listen); clarify to avoid misunderstanding; show appreciation for willingness to resolve conflict; take a time out / check back -if possible; separate work and personal life; take care of yourself (eat well, sleep well, exercise, have sex)
Dealing with someone who is angry
Agree that they might be right; admit they may have a right to be angry; listen; refer them to a supervisor or manager.
Sexual harassment policy; freedom from unwanted advances; freedom from hostile work environment; what to do - deal directly, document, tell friend (advocate), make informal complaint to supervisor, file formal grievance.
Where do nurse values come from?
Concepts of holism, beliefs, attitudes, behaviors, nurse practice acts, scope of practice, standards of care, state and federal laws, american nurses association, the joint commission, nurse specialty organizations.
Ethical responsibilities related to professional nurse practice
Autonomy, beneficence, non-maleficence, justice fidelity, veracity, confidentiality, accountability.
Right to be self determined; to make decisions based on ones own values, adequate information and sound reasoning that considers all of the alternatives
Benefiting others; intent of acting in the best interest of the client
Avoidance of harm or hurt; choosing the least harmful intervention that will provide the most benefit
Intending to treat others fairly and giving what is due or owed
Faithfulness to patient and co-workers and institutions; keeping promises
The value of honestly telling the truth
Respecting the privacy of information; HIPPA
Taking responsibility for the consequences of your performance; mistakes or negligence
deliberate attempt or threat to inflict bodily injury upon another person and with the apparent ability to do so.
illegal touching of another person
deliberate deception; intended to produce unlawful gain
the condition of being actually or potentially subject to legal obligation
improper or illegal practice as in medicine or law
failure to take responsible precautions to protect others from the risk of harm
false charges; written or published information that causes unjust damage to a persons reputation
the utterance of false charges that damages someones reputation
Patient Self-Determination Act of 1991 (PSDA)
requires all HCF to have written P&P concerning advanced directives and give this information to all patients upon admission
gives an individual a right to accept or refuse treatment in advance of a situation where they are unable to communicate their wishes and they will surely die, ie. DNR, DNH
do not resuscitate; written order by a physician if a person does not want CPR in the event of cardio-pulmonary arrest; generally seen in terminally ill and elderly pts.
legal document in which patient makes their wishes known regarding life sustaining measures if they become incapacitated; ie. cpr, ventilators, feeding tubes, IV fluids
Health care power of attorney
appoint someone to make medical decisions for you if you are unable
What rights do we advocate for our clients
patient care partnership (pt. bill of rights); proper use of restraints; informed consent (must be fully informed before signing a consent form); right to refuse (must be informed of the consequences and documented); OBRA
Documenting expected or unexpected events
document: incident report must be completed for any occurrence that causes or has the potential to cause injury to the client or staff; medication error report; USPMERP 800-23-ERROR.
Internal or external disasters
computer crash, power outage, terrorist attack, natural disasters
RACE and PASS; Rescue Alarm Contain Extinguish; Pull pin Aim Squeeze trigger Sweep at base of flame.
TJC tracks these incidences; ie. amputation of wrong leg, baby abduction, surgery on wrong person, patient suicide
implementation of policies that reduce danger or hazard; reduces risk of liability to institution; identifies problems; prevents or reduces risk of occurrence; prevents patient injury; organization liability
Accidental error prevention
identify potential; protect from; monitor environment; verify orders; human factors engineering
Reducing risk for yourself
carry malpractice insurance; protecting yourself means protecting your patient; dying persons bill of rights; pain care bill of rights; patient care partnership
Basic concepts related to health care employment
standards of care differ for physicians and nurses which is held to a much higher standard than lay persons; will be held to the standards of any action or duty to the scope of practice standards of care wherein that particular duty falls; ie. if a nurse performs a brain surgery, they will be held to the standards of practice of a physician even though its out of their scope of practice; so don't practice out of scope anytime anywhere.
the joint commission; the state, ACHC, NCQA, URAC, AOA, CHAP, CARF, ???
develop standards of care, support research, provide educational opportunities, lobby for nursing issues ANA, NLN, INS, NAVAN, ONS, also CC, ER, OB, OR.
Emergency preparedness plans
Trauma, BLS, fire plans, multiple accident plans
Required forms and treatment
informed consent, EMTALA (emergency medical treatment active labor act) - cannot turn away a woman in active labor even if they are not able to pay.
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