207 Foundations I (Term 2) - Midterm Study Cards Flashcards
Prepare for Foundations I Midterm.
List the five ethical principles.
- Autonomy
- Nonmaleficience
- Beneficence
- Justice
- Fidelity
List the values noted in the CNA Code of Ethics.
- Providing safe, compassionate, competent, and ethical care
- Promoting health and well-being
- Promoting and respecting informed decision making
- Honouring dignity
- Maintaining privacy and confidentiality
- Promoting justice
- Being accountable
What are the different aspects of informed consent.
- legal and ethical right
- right to refuse
- has clear understanding
- capable of consenting
- can be withdrawn at any time
- informed consent can be formal or implied
What are the 5 C’s of relational enquiry?
- Compassionate (To share in suffering and be present)
- Curious (Being interest and inquisitive and open to uncertainty)
- Competent (Performing without causing harm, knowing own knowledge and skills)
- Commitment (active and conscious assessment of values, ensuring actions are aligned with values)
- Correspondence (Relating to people in a way that is meaningful to them)
Define compassionate.
The ability to recognize and be aware of the suffering and vulnerability of another, coupled with a commitment to respond with competence, knowledge and skill. (CNA)
Define health care law.
Collection of laws that have a direct impact on
the delivery of health care or on the relationships among those in the business of health care or between the providers and the recipients of health care.
List the three strands for the scope of health care law.
Legislative: introducing, changing,
repealing law
Regulatory: Putting laws into actions using
rules
Judicial Decisions: Previous court cases as
supportive tool
What are the attributes of health care law?
- Rule is established by gov’t body/agency (may be federal, provincial, local)
- Has enforceable sanctions
- Is publicly available
- Consistent with provincial and federal laws
- Can be modified, changed, or upheld through authoritative action
Define fiduciary responsibility.
Wherein the nurse provides services that cause the recipient (patient, family, group) to
be able to trust in the expectations of a specialized body of knowledge and the professional integrity of the provider.
The public at large expects that RNs act honestly, and in good faith. It is this relationship
that forms the basis of nursing practice.
What organization is the regulatory and professional body for RNs in Alberta?
College and Association of Registered Nurses of Alberta (CARNA)
List the 5 standards of practice outlined by CARNA.
Standard One: Responsibility and Accountability Standard Two: Knowledge-Based Practice Standard Three: Ethical Practice Standard Four: Service to the Public Standard Five: Self-Regulation
Define scope of practice for registered nurses.
Scope of practice refers to the knowledge of registered nurses and the comprehensive
application of that knowledge to assist clients in meeting their health needs in whatever
setting, complexity and situation they occur throughout the life span. Scope of practice includes all the interventions that registered nurses are authorized, educated and competent to perform.
Give three examples of what would be considered intentional tort.
- Assault
- Battery
- Invasion of privacy
- False imprisonment
What is a tort called when it is not intentional?
negligence
List the phases of the nursing process that should be documented by the nurse.
Assessments, history, and observations of the client’s health status including both normal and abnormal findings.
Diagnostics, planning, and interventions including care, treatment, services, and health teaching.
Evaluations of the care, treatment, and services provided, noting how the client responded, and any necessary follow-up.
Why is documentation so important? List some of the reasons.
- Communication, continuity of care, and clinical judgment
- client safety
- quality improvement
- funding
- legal
- research
- population and clinical health insights
List the possible components of a client’s health record.
- admission sheet
- progress notes or interdisciplinary notes
- referral and consultations
- Diagnostic, laboratory, and therapeutic orders
- Medication administration record
- Flow sheet and graphic record
- Kardex or summary sheet (These forms summarize important information that should inform your daily care of the client and must be continually updated during each shift.)
- nursing care plan
- operative procedure
- Consent forms, resuscitation forms, and healthcare directives
- Discharge plan and summaries
- Critical incidents
- workload measurement
What might a discharge plan include?
- Education about their condition or disease.
- A list of medication including the name, dose, route, and frequency as well as adverse effects to watch for.
- Guidance surrounding nutrition in terms of the client’s diet (i.e., what they should eat, how often, what they should avoid).
- Information about mobility and mobility aids, such as specific goals in terms of activity and exercise (amount and frequency), and information about aids such as crutches or a cane and how to use them.
- Access to resources in the community such as homecare, rehabilitation, and meal-delivery services.
- Information about when to seek healthcare if the client experiences specific symptoms, adverse effects, or complications, and appointments related to follow-up care.
- Finally, this form documents the date/time of discharge and how the client is getting home (e.g., transportation and whether they are accompanied by someone).
What is the CARNA standard related to documentation?
- : Nurses document the nursing care they provide accurately and in a timely, factual, complete and confidential manner.
Documentation must be all of the following:
Factual Accurate Complete Current Organized Compliant with standards
Define development.
The sequence of physical, psychosocial, and cognitive developmental changes that take place over the human life span.
What three aspects integrate together and are represented by the umbrella term ‘development”?
growth, differentiation, and maturation
What is the scope of development?
Applies to the following domains: Physical/Physiological Motor Cognitive Communication Social/Emotional Adaptive
How would you define the ethical principle of autonomy?
Individual has the right to choose.
How would you define the ethical principle of nonmaleficence?
Do no harm
How would you define the ethical principle of beneficence?
Act of doing good; as best as you can for the patient.
How would you define the ethical principle of justice?
Fairness and equity.
How would you define the ethical principle of fidelity?
Ability to be trustworthy.
A nursing code of ethics:
a) Provides specific ways to behave with patients
b) Has definite guidelines for decision making
c) Permits nurses to decide what is best for their patient
d) Provides guidance for relationships, behaviour and decision making
D) provides guidance for relationships, behaviour and decision making
True or false. The Code of ethics includes all of the following:
- statement of ethical values of nurses and nurses commitments to persons with health care needs
- intended for nurses in all contexts
- provides guidance when nurses are working through ethical challenges
- Includes responsibility, accountability and advocacy
True
Relational practice is:
a) an authentic style of being
b) a style of communication
c) a holistic approach to care
d) a synonym for an interpersonal relationship
C) a holistic approach to care
Define relational care.
An approach to nursing practice that allows the nurse the ability to better understand the nurse-patient context beyond the surface.
Define relational practice.
Conscious participation with clients using listening, questioning, empathy, mutuality, reciprocity, self-observation, reflection and a sensitivity to emotional contexts.
Define clinical judgment.
An interpretation of conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient response.
What are the five stages of Patricia Benner’s Novice to expert model?
Novice: has no professional experience
- Beginner: Can note recurrent meaningful, situational components, but not prioritize between them
- Competent: Begins to understand actions in terms of long-range goals
- Proficient: Perceives situations as wholes, rather than in terms of aspects
- Expert: Has intuitive grasp of the situation and zeroes in on the accurate region of the problem
What are the three aspects of the scope of clinical judgment?
1) Standards-based approach
2) Interpretivist perspective
3) Evidence-based practice and clinical judgment
What does the standards-based approach of clinical judgment often entail?
Often uses algorithms, decision trees, patient care guidelines or standards of care. Rules based.
What are some limitations of the standards-based approach?
- not patient-centered care
- may be outdated
- doesn’t account for geographical differences
- reduces use of critical and clinical thinking
What does the interpretivist approach account for?
Accounts for what the nurse personally contributes to the caring encounter, including previous experiences, values and emotions.
- Empirical knowledge of the disease process
- Knowledge of the patient
- Knowledge of the clinical environment
Involves tacit or understood knowledge
What is evidence-based practice defined as?
Defined as a problem solving approach to clinical decision-making that combines the best available scientific evidence with best available patient and practitioner experiential evidence toward optimal healthcare outcomes
Identify the attributes and criteria of clinical judgement.
- Holistic view of the patient situation
- Process orientation
- Reasoning and interpretation
- Ethical comportment
What does the holistic view of the patient situation involve?
Willingness to consider all of the factors involved in patient care, including:
- Characteristics of the nurse (theoretical and experiential knowledge, values, biases)
- Relationship with the patient
- Context of care
What does process orientation involve?
Clinical judgment is circular, interactive, and moves fluidly between and among all of the aspects of the nursing process
Not a linear relationship; complex interactions (unknowns, multiples factors, no clear-cut answers)
What do reasoning and interpretation involve in the context of clinical judgment?
Reasoning is the process that leads to clinical judgments
Nurses use three types of reasoning as the scenario dictates:
- Analytic (usually when the situation is new)
- Intuitive (based on broad and deep experience, a nurse may intuitively recognize what needs to be done)
- Narrative (recognizing the significance of the situation at hand to the patient’s experience with illness and engaging in interventions based on this understanding.
What does ethical comportment involve in the context of clinical judgment?
Come to a situation with an outlook of what is right or good for the patient and manifests in respect, responsiveness, and support towards the patient.
Define nursing metaparadigm
Encompasses the various conceptual frameworks that attempted to define nursing
Includes the concepts of person, environment, health care, and nursing care.
Person: the individuals receiving the nursing care
Health: the state of illness or health
Environment: Where the nursing happens
Nursing: The care provided for patients
Describe Carper’s Ways of Knowing.
- Empirical knowledge (science of nursing)
- Ethical (moral knowledge in nursing)
- Personal (acceptance of self grounded in self knowledge and confidence)
- Aesthetic (art of nursing)
- Emancipatory (addresses the social and political context - advocate for patient)
What are the five steps of the nursing process?
Assessment Diagnosis Planning Implementation Evaluation
What is involved in the ‘Assessment’ phase?
Uses subjective (what the client or family tells you), objective (what you gather using your senses and skills, touch, vision, hearing, smell, vital signs), biographical and historical date
Considers growth and development and the determinants of health
Requires the clustering of data and identifying the relevance of data
What is involved in the ‘Diagnosis’ phase?
Focuses on nursing problems
nurses cannot fix medical problems
Starts with analyzing assessment data
Three part diagnosis:
P (problem): The nursing diagnosis label; a concise term or phrase that represents a pattern of related cues. Taken from NANDA.
E (etiology): “Related to” (r/t) phrase or etiology; related cause or contributor to the problem
S (symptoms): Defining characteristics phrase: symptoms that the nurse identified in the assessment
What are the different types of nursing diagnoses?
Types of nursing diagnoses:
Actual/problem based: three part diagnosis (PES)
Risk nursing diagnosis: two part diagnosis (PE)
Health promotion diagnosis: two part diagnosis (PS)
What is involved in the ‘Planning’ phase?
Involves the client’s input to create goals/outcomes
SMART goals
Include both short-term and long-term goals
Needs to be evidence-informed
Provides your ‘why’ - your rationale for your actions
What is involved in the ‘Implementation’ phase?
Initiation of care Performing interventions Assessing effectiveness Ensure intervention is appropriate for client Know the rationale for all interventions Documentation
What is involved in the ‘Evaluation’ phase?
Actually occurs throughout the nursing process
Involve client and family
Revisit the outcomes to ensure they were SMART
May need to change interventions to meet dynamic client needs
Document and report
Define primary health care
PHC is comprehensive care that includes disease prevention, community development, a wide spectrum of services and programs, working in interprofessional teams, and intersectoral collaboration for healthy public policy
List the social determinants of health.
Income and social status
- Social support Networks
Education and literacy
Employment and working conditions
Physical environments including geography, food security, and housing
Biological and genetic endowment
Individual health practices and coping skills
Healthy child development in early life
Healthcare Services
Gender
Culture including immigration status, indigeneous ancestry and race
Social environmentsIdentify the attributes of primary health care.
According to CNA:
- Accessibility: A continuing and organized supply of essential health services is available to all people with no unreasonable geographic or financial barriers
- Health promotion: The process of enabling people to increase control over and to improve their health.
- Public participation: Individuals and communities have the right and responsibility to be active partners in making decisions about their health care and the health of their communities.
- Intersectoral collaboration: Commitment from all sectors (governments, community, and health) is essential for meaningful action on health determinants.
- Appropriate technology: This includes methods of care, service delivery, procedures and equipment that are socially acceptable and affordable.
Which of the following are included in the four pillars of primary health care? (select all that apply)
a) Teams
b) Healthy living
c) Access
d) Funding
a), b), c)
Not funding
The primary health care principle of intersectoral collaboration is:
a) nurses working with other health care professionals
b) working in partnership with others
c) all health sectors working together to address the determinants of health
d) communities working together
d)
Which of the following ideas is most likely to improve health care in Canada?
a) Increasing funding and personnel to advance new pharmaceutical interventions.
b) Increasing funding for further research into the most effective medical interventions.
c) Increasing technological advance to constantly improve surgical survival rates.
d) involving communities in their health care and encouraging participation in decisions about health care.
d) involving communities in their health care and encouraging participation in decisions about health care.
Compare and contrast primary care from primary health care
Primary care (PC) focuses on personal health services, whereas primary health care extends beyond PC to include health education, nutrition, maternal and child health care, family planning, immunizations, and control of locally endemic diseases.
Which publication added precursors to health including human rights, womens empowerment and social relations?
Jakarta Declaration
Which publication recognized the impacts of a behavioral approach to health?
Lalonde Report
Which publication identified that primary health care was the precursor for health for all?
Alma Ata
Which publication identified precursors for health including peace, shelter, and education for example?
Ottawa Charter for Health Promotion
Which publication identified three challenges to be addressed for health including reducing inequities, increasing prevention, and increased coping?
Epp Report
What are the five pillars of the Health Care Act (HCA - 1984)?
Public administration Comprehensiveness Universality Portability Accessibility
Define health care setting.
Where individuals seek or receive health care services; the various settings/locations for health care delivery.
What are the three categories of health care settings?
Institutional sector
Community and voluntary sector
Private sector agencies
What is the scope of health care settings?
Remote to rural
What are the attributes/types of facilities associated with the institutional sector?
- hospitals
- long term care facilities
- psychiatric facilities
- rehabilitation centres
What are the attributes/types of facilities associated with the community and voluntary sector?
Public health Physician Offices Community Health Centres and Clinics Assisted Living Home Care Adult Day Support Programs Community and Voluntary Agencies Occupational Health Hospice and Palliative Care Parish Nursing
What are the three tiers of the current health care structure in Canada?
- federal jurisdiction
- provincial/territorial jurisdiction
- professional jurisdiction
What are the attributes associated with the federal government’s involvement in health care delivery?
Set and administer Health Care Act principles
Assist in financing provincial/territorial health care services through transfer payments
Deliver and co-deliver health services for targeted groups
Provide national programming and policy to promote health and prevent disease
What are the attributes associated with the provincial and territorial government’s involvement in health care delivery?
Develop and administer its own health care insurance plan
Manage, finance, and plan insurable health care services and delivery in compliance with the Health Care Act
Determine organization and location of health care facilities
Reimburse physician and hospital expenses
Each provincial and territorial plan is unique in coverage
What are some of the roles of the nurse in selected health care settings
- Care of individual patients
- Coordination of care and case management
- Health promotion, disease prevention and support for self management
- Program development
- Management of chronic illness
- Liaison with hospital services
- Administrative management in Primary Care
What are the purposes of documentation?
Facilitate continuity of care Track outcomes Communicate to team members Prove that health care was undertaken Act as evidence in a court of law Confirms suitable professional practice
What is the accepted (though arbitrary) age range for young older adults?
65-74
What is the accepted (though arbitrary) age range for middle older adults?
75 -85
What is the accepted (though arbitrary) age range for old older adults?
85+
Are symptoms such as disorientation, loss of language skills, loss of ability to calculate, and poor judgment normal processes of aging?
No, though some structural and physiological changes within the brain are normal with aging
Define failure to thrive.
a loss of weight and subsequent loss of linear growth
What are some of the causes for failure to thrive?
- organic causes
- exogenous or non organic causes
- mixed
Refers to the growth and changes in body tissues and organ systems and the resultant changes in body functions and proportions.
Physical/physiological
Frequently separated into two major categories: gross and fine motor. Very generally, motoric development progresses from achievement of gross motor to fine motor skills—a process referred to as refinement.
Motor
Relates to working memory capacity, cognitive self-regulation, and the processing and use of information about the environment and objects in the environment.
Cognitive
Speech is the spoken expression of language. The three components of speech are (1) articulation, which refers to the pronunciation of sounds; (2) voice, which refers to the production of sound by the vocal cords; and (3) fluency, which refers to the rhythm of speech. Language involves a set of rules shared by a group of people that allows the communication of thoughts, ideas, and emotions.
Communication
Includes the development of self-understanding, understanding others, and understanding social interactions.
Social/Emotional
Refers to the acquisition of a range of skills that enable independence at home and in the community.
Adaptive
refers to an individual’s stage of development (e.g., stage of epiphyseal closure in long bone development, Tanner stage of pubertal development, and stage of cognitive development) or ability to independently achieve an outcome (e.g., perspective taking and abstract reasoning)
developmental level
an ability or specific skill that most individuals can accomplish in a certain age range.
developmental milestone
If an individual does not accomplish milestones within a specified age range, or a critical period.
developmental delay
The loss of developmental milestones
Developmental regression
plateau of developmental change in some category and is noted when chronologic age continues to progress but developmental change does not.
developmental arrest
List three major developmental theories.
Piaget
Erikson
Kohlbert
Developmental theory that postulates that when a conflict in universal values occurs, a moral choice must be made This choice is based on moral reasoning, which is postulated to develop progressively over three levels: preconventional (18 months to 5 years), conventional (6 to 12 years), and postconventional (12 to 19 years)
Kohlberg’s Stages of Moral Development
What age range correlates to Kohlberg’s preconventional level?
1 - 10 years
What age range correlates to Kohlberg’s conventional level?
10 to 19 years
What age range correlates to Kohlberg’s postconventional level?
19 and above
Development theory where cognitive development is viewed as progressing from illogical to logical, from concrete to abstract, and from simple to complex.
Piaget.
What are the 4 stages of Piaget’s Stages of Cognitive Development?
- Sensory motor
- Preoperational
- Concrete operational
- Formal operations
What age range correlates to Piaget’s sensory motor level?
Birth to 2 years
What age range correlates to Piaget’s preoperational level?
2 - 7 years
What age range correlates to Piaget’s concrete operational level?
7 - 11 years
What age range correlates to Piaget’s formal operational level?
11 years +
Theory of development that is focused on the psychosocial development of an individual across the life span
Erikson’s Stages of Psychosocial Development
List the 8 stages of Erikson’s theory.
- Trust vs. mistrust
- Autonomy vs. Sense of shame and doubt
- Initiative vs. guilt
- Industry vs. inferiority
- Identity vs. role confusion
- Intimacy vs. isolation
- Generativity vs. self-absorption
- Integrity vs. despair
What age range correlates to Erikson’s Trust vs. mistrust level?
birth to 18 months
What age range correlates to Erikson’s Autonomy vs. Sense of shame and doubt level?
18 month to 3 years
What age range correlates to Erikson’s Initiative vs. guilt level?
3 - 6 years
What age range correlates to Erikson’s Industry vs. inferiority level?
6 - 12 years
What age range correlates to Erikson’s Identity vs. role confusion level?
12 - 19 years
What age range correlates to Erikson’s Intimacy vs. isolation level?
19 - 35 years
What age range correlates to Erikson’s Generativity vs. self-absorption level?
35 - 60 years
What age range correlates to Erikson’s Integrity vs. despair level?
60 +
What are the five Cs of relational inquiry?
- Compassion
- Curiosity
- Competence
- Commitment
- Correspondence
Which of the 5 C’s: To share in suffering and be present.
Compassion
Which of the 5C’s: Active and conscious assessment of values, ensuring actions are aligned with values.
Commitment
Which of the 5C’s: Relating to people in a way that is meaningful to them.
Correspondence
Which of the 5C’s: Being inquisitive and interested and open to uncertainty
Curious
Which of the 5C’s: Performing without causing harm, knowing own knowledge and skills.
Competence
Define integrity.
Adherence to moral norms that is sustained over time. Implicit in integrity is soundness, trustworthiness, and the consistency of convictions, actions and emotions.
What are the effects compassion has on patient outcomes?
Results in higher patient care satisfaction
Better health outcomes for patients
Compare and contrast relational practice to relational inquiry.
Relational inquiry: An approach to nursing practice that allows the nurse the ability to better understand the nurse-patient context beyond the surface
Relational practice: Conscious participation with clients using listening, questioning, empathy, mutuality, reciprocity, self-observation, reflection and a sensitivity to emotional contexts.
What are the relational capacities?
- initiative
- authenticity
- responsiveness
- honouring complexity and ambiguity
- mutuality and synchrony
- intentionality, relating and reimagining
Within the context of the nursing process and the assessment stage, how would you prioritze?
- ABC/CAB
- Maslow’s HON
- Acute vs. Chronic
- Actual vs. Potential
