Discipline of Professional Nursing Flashcards
mission statement of the BN program
aims + values of program
to prepare graduates who practice nursing as knowledgable, competent and caring health professionals and contribute to society as learned, innovative and thinking citizens
philosophical beliefs
HEALTH
- is an asset
- includes biological, physical, psychological, social, developmental, cognitive, cultural, and spiritual aspects
- is influenced by many factors
achievement of health
reaching optimum level of well being for the individual / community
philosophical beliefs
PERSON/INDIVIDUAL & CLIENT
- someone with unique traits, beliefs, values + perceptions
- client can be person, family, group, community, society, humanity
philosophical beliefs
ENVIRONMENT
greatly impacts health and is the surroundings + atmosphere where clients live
philosophical beliefs
NURSES & NURSING STUDENTS
- a professional discipline
- primary role = develop relational partnerships with clients to support and assist them to reach optimal health
- achieved by developing a nurse-client relationship
philosophical beliefs
NURSING EDUCATION
- transforms students into professional nurses
- acquisition of knowledge, skills, behaviours, perspectives, and attitudes
philosophical beliefs
TEACHERS & TEACHING
- create positive learning climate
- facilitate, coach, support
philosophical beliefs
LEARNERS & LEARNING
- critical, active, inquisitive, interactive, reflective + lifelong
- meaningful synthesis (shared)
philosophical beliefs
TEACHING & LEARNING PARTNERSHIP
- based on shared responsibility
- teachers have inherent power
role of student
- consumers of education
- take advantage of support services
- learn to be: critical, inquisitive, reflective
role of teacher
- create a positive learning environment
- assist students in learning self-directed and reflective learning
- help students become “professional learners”
- facilitator
- coach
- role model
concept
mental formulation of an object or event; can either be concrete (readily observable) or abstract (non observable)
conceptual framework
a group of related concepts - which provides an overall view of the relationship between concepts
- “paints a picture” of what nurses do
what is a relational practice?
- dynamic approach - acknowledges “in that moment”
- nurse-client partnership is at the centre of the relationship
- this partnership changes and evolves according to needs of client (always client centred)
philosophical beliefs
- approach/framework that guides nurses behaviours
- acknowledges context that plays a major role in health
- it ensures all interactions are purposeful and useful to the client
art + skill of being able to connect with client
6 relational nursing obligations
- nurse as inquire not an expert
- be reflexive + intentional
- open the relational space
- explore client experience by actively listening
- identify clients understanding of experience
- be aware of meaning and context in client experience
context
- circumstances in which situations occur
- “in the moment” & continuously changing
- nurse & client have unique contextual influences
factors that impact partnership
- characteristics of partnership
- health status of client
- expectations and beliefs of client
- knowledge + experience of nurse
- professional expectations of nurse
- environment
what is the most important framework in nursing?
self reflection!
barriers
- technology driven HCS
- prescriptive outcomes
- standardize care
- patients viewed as the problem to be solved
- top-down approaches
- workload & lack of support
benefits
- focus shifts from nurse to client/family
- shift from doing collaborating
- increased insight into clinical experience
- minimize medical or relational harm to client
- empowers client to take the lead in their own health outcomes
entry level outcomes
minimal required skills and knowledge that graduates are expected to have in order to provide safe, competent, and ethical care
the professional nurse
has their own values, beliefs, but are also being guided professionally by standards set in place externally
nursing practice contains:
- code of ethics
- Canadian entry to practice competencies
- nursing practice standards
- interprofessional collaboration competencies
who are RN’s?
- 10% male
- 48% age 35-54
- ~60% work in acute care (med/surg, operating room, long term care, emergency/ICU, L&D)
- more than 60% full time
- 21 healthcare professions
- SELF REGULATED
college of registered nurses of Manitoba (CRNM)
- sets standards for RN education and practice in MB
- mission - to protect and serve the public
- promote good nursing practice
- prevent poor nursing practices
- intervene in cases of poor practice
association of regulated nurses of Manitoba (ARNM)
- a provincial professional voice for nurses
- support + promote excellence in nursing practices, education, research, leadership + policy
- advocate for RN + health of people living in MB
Canadian nurses association (CNA)
- national, professional voice for nurses
- speaks for and represents nurses to other organizations + government
- publish the code of ethics (CoE)
- influence health policy
- promotes the role of the RN
requirements to be an RN
- complete recognize education (diploma 2-3 years)
- pass NCLEX
- complete criminal record check
why has nursing education changed?
- healthcare has changed
- once educated in hospital (back in the day), education has moved into colleges and universities
- bachelor degrees have slowly replaced diplomas as entry to profession
how can you remain an RN?
- in MB, RN’s must register and complete a continuing competence program (CCP) annually
licensed practical nurses (LPN)
- 2 year program
- have a specific role within healthcare system
- may have a limited scope of practice, often influenced by employer policies
registered psychiatric nurse (RPN)
- less than 1000 in MB
- largest group of mental health professionals
- 4 year bachelor degree (focus on mental health illnesses)
nurse practitioners (NP)
- RN with advanced education
- order diagnostic tests + prescribe drugs
- perform invasive procedures
when do RN’s work?
- Shiftwork (provides flexibility)
- challenges = include childcare, impaired sleep
- shifts longer than 13 hr (increased medical errors, pts are dissatisfied with care, risk of burnout, fatigue, “drowsy driving” in nurses)
- absenteeism up to 19 days/year
6 characteristics of nursing
- accountability
- specialized body of knowledge
- competent application of knowledge
- code of ethics
- service to the public
- self-regulated
accountability
- legally answerable decisions we make as a nurse
- as a student nurse practice accountability (due dates, pulling your weight in group projects, stand behind the work you do)
specialized body of knowledge
specific nursing knowledge has shaped the specialized body of knowledge nurses have
competent application of knowledge
we have specialized body of knowledge but we also have to know how to use it + apply it
code of ethics
“rules” that must be followed related to ethical practice
service to the public
nurses are driven to do good for the patients and for the public
self regulated
we are regulated by other nurses. government awards healthcare professionals because few people outside the profession have the specialized knowledge
the value of having more RN’s
- shorter lengths of stays and better discharge planning + fewer re-admissions
- lower rates of medication errors
- lower rates of hospital acquired infections (UTI + pneumonia) + pressure ulcers
- saves healthcare system $$
social forces affecting the image of nursing
- viewed as women’s work
- “feminine” virtues: caring, nurturing, tenderness, selflessness
- most sexualized profession
can nursing students help improve the image of nursing?
- speak positively about nursing
- pay attention to the work of nurses
- use a critical eye when observing nurses in media
- practice professional behaviours in + out of the classroom
- become involved with ARNM
how are patients labeled in healthcare
- patient historically came from paternalistic model of healthcare
- movement towards client centeredness - the word client was adopted
- labels are powerful and can influence a therapeutic relationship
define disease
the “physiological deviation for normal”
define illness
the “experience of living with a disease”
T or F
a patient who reports poor health and wellness often experience less stress?
FALSE patients with poor health and wellness experience more stress
why does it matter if patients are dealing with stress?
- hospitalizations can cause feelings of uncertainty, fear, powerlessness, and anxiety
- as a nurse you see patients at their most vulnerable
- patients families, and HCW all experience stress
- stress shows up in many different ways - knowing how to recognize it can strengthen you therapeutic relationship
what is stress?
a non specific response of those to any demand made on it. occurs when individuals perceive that they cannot cope adequately with the demands being made on them if their well being is threatened
what are stressors?
events or demands that activate stress responses in the body
2 types:
physiological and psychological
physiological stress
stress on joints from running and infection can activate the stress response in the body, experiencing physical pain / injury, giving birth, inadequate nutrition
emotional / psychological stress
learning about something sad/tragic, relationship conflict, financial struggles, grieving, due dates about exams
involuntary VS primitive stress response
involuntary = do not have control over it
primitive = has been with us for a long period of time
what are the 2 stress response systems?
sympathetic adrenal medullary (SAM) + hypothalamic pituitary adrenal (HPA)
symptoms of stress response
SAM = releases epinephrine
HPA = releases cortisol
both:
- increase HR (tachycardia)
- increase BP
- increase breathing rate (tachypnea)
- increase blood sugar levels
- blood rushes to brain + skeletal muscles
- increase awareness + alertness
- decreased digestive activity
- impaired immune system
- decrease reproductive activity
what does stress look like?
using a relational, client centred approach, it will be important for RN to understand + acknowledge that patients choice, decision + behaviour may be motivated by stress
factors that influence response to stressors
- intensity
- scope
- duration
- number + nature of other stressors
- past exposure to serious stressors
- predictability
characteristics of the individual that influence the stress response
- age
- gender
- perception of personal control or inescapability
- availability of social supports
- feelings of competence
cognitive appraisal
define coping
active process of managing taxing circumstances, expending effort to solve personal and interpersonal problems + seeking to master, minimize, reduce, or tolerate stress
(things you do to lower stress)
positive coping VS negative coping
negative = substance use, cannabis, tobacco, shopping, avoidance, withdraw from situations, controlling everything, acting out, etc
positive = deep breathing, meditation, delegating, showing emotion, journal writing, pet therapy, etc.
how can we help patients cope?
- bring in familiar objects to hospital (blanket, pictures, etc)
- encourage to ask questions about care
- keep promises
- be truthful
- encourage them to ask for what they need
define noncompliance
the mismatch between what is prescribed in terms of medication or lifestyle change and what client actually does
why are clients non compliant?
- lack of understanding / education
- financial circumstances
- social circumstances
- the way medications are prescribed
- uncomfortable side effects
it CANNOT be assumed noncompliance is because patient is refusing to follow advice
complications of high stress
- physiological consequences: nausea / vomiting, irritability, dizziness, perspiring + crying
- psychological consequences: depression, anxiety, low levels of self confidence, poor concentration + loss of motivation + ability to focus
causes of stress in nursing school
year 1 = difficult to find balance between person life + academic demands
year 2 = improvement in well being, increased expectations / workload, not enough time for personal life
year 3 = improvement in well being (time management + organizational skills helped)
coping strategies used by students
- seeking emotional supports from classmates, family, friends
- reflecting, reorganizing, responding
- exercising + getting outdoors
- organizing, planning + prioritizing
what will nursing school require?
- motivation
- organization
- strategies
how can a nursing student stay organized?
- plan - what must be done / what should be done
- anticipate - can you predict what might interfere / can you find out how long readings / assignments might take
- delegate - are there tasks / responsibilities that you can ask someone else to do
how to manage stress
- use strategies that worked in the past (exercise, nutrition, socializing)
- accept help from others (friends, family, support services)
tips for building professional relationships (teacher/student)
- get to know prof
- take charge of learning
- ask for feedback
-review tests + assignments - take responsibility if its not going well ask for help
tips for learning in lectures
- come prepared
- listen for cues (concepts that are repeated, emphasized, summarized
- DO NOT write everything down
- try to review notes within 24 hours of class
- develop questions you don’t understand
what is the number 1 source of stress in nursing students
clinical practice
define academic integrity
adherence to moral and ethical principles (honesty)
academic misconduct
dishonest behaviour related to academic work
- plagiarism
- cheating
- false or misleading representation
- collusion
define plagiarism
representing the words, ideas, research or data created by or belonging to someone else as if it was your own
define cheating
use or distribution or the attempted us of distribution of unauthorized materials, equipment, information or study aids when engaged in academic work
- includes: unauthorized materials during a test, copying work from another student, impersonation of someone else during a test, using a book in a closed book test
define false or misleading representation
misrepresenting, exaggerating, withholding info, or providing any false info for academic or financial benefit (signing for meds not given)
define collusion
carrying out or attempting to carry out an agreement with any other person to commit an act of academic misconduct
why do nursing students cheat?
- believe the content is not relevant to being a nurse
- believe assignment / exam is not fair
- believe it is the only way to deal with heavy workloads
- strong focus on achievements / grades
- students have used the approach in the past
- believe it is a victimless crime
what are the strategies for learning with integrity?
- build your reputation
- prepare for each assignment
- get the right support
- improve academic writing skills
- write tests with integrity
how will you become a nurse?
take what you already know and connect it to the new info being presented!
learning is often uncomfortable but that’s where true learning occurs!
what are nurses responsible + accountable for?
RNs are responsible for accepting these standards and accountable for meeting these standards
should RNs disclose their first and last name?
yes, when introducing yourself to a nurse you should say your first and last name and your title
responsibility as a student nurse/registered nurse
- reliable + dependable
- distinguish between right + wrong
- performing adequately + thoughtfully
- essential for gaining clients trust
- means accepting expectations (standards)
define answerability
you need to be able to answer to the choices that you make as a nurse - you are accountable for why you did or didn’t meet expectations
to earn the title RN, you must:
- keep up with professional standards, laws, regulations
- ensure you have the skill to do your job
- maintain fitness to practice (physical, mental, emotional) to practice safely + competently
- share knowledge through mentorship + feedback with colleges
- advocating for comprehensive + equitable mental health care services
as a nurse who are you accountable to?
the public (clients + patients), profession of nursing, your employer/school, + society as a whole
client entered practices (CCP) / client centred care (CCC)
it’s an approach to care in which the patient retains control over their own care
- views the patient as a whole person, with life experiences, feelings, family and work responsibilities
- nurse provides knowledge/skills to help patients make their own decisions
what are the values + beliefs of CCC
- respect - autonomy, voice, self-determination (allow them to have their own opinions + making their own decisions - autonomy is the ability to make an informed decision without being pressured)
- human dignity - treat patient as an individual, not as a disease or a problem (ex. viewing patients as a whole - not as a “diabetic” but instead as a individual living with disease)
- clients are experts for their own lives even if they are not experts on their own diseases
- clients should be leaders in the health care team (patients should be informed about their diagnosis + plan)
what are some challenges to CCC?
- limited resources (not time - cannot access everything patient needs)
- staff attitudes (believing there is more important things to do)
- use of routines / standardization
- systems within the hospitals
this is when a healthcare provider believes they know what is best for the patient (visiting hours for example)
what is competent practice?
practice the nurse makes to maintain and enhancing nursing knowledge, skills, and judgement in your practice so it is both safe + relevant to clients needs
- practice is informed by evidence (gathered from types of knowledge + evidence informed sources + develop + maintain competence)
what is evidence?
provides rationale behind why nurses choose to practice in a certain way
what are the 5 professional practices: patterns of knowing
- empires: the science of knowing
- esthetics / artistic: the art of nursing
- personal knowledge: the knowledge of yourself
- ethics: the moral component
- emancipatory: social, economic, + political component
describe the empirical way of knowing
looking at surveys - ex. making breakfast for someone and wanting to know what kind of eggs they like to eat so you look at a map of the most liked eggs in your area
describe the artistic way of knowing
looking at someones face / body language
describe the personal way of knowing
reflect back on yourself
describe the ethical way of knowing
is it right or wrong / good or bad
describe the emancipatory way of knowing
unequal access, recognize inequity + working with the community to effect positive change
define empirics
the science of nursing
- knowledge developed through systematic research to describe + explain phenomena
- research should follow strict guidelines to ensure quality
- sometimes hard to integrate into practice
describe aesthetic / artistic
the art of nursing / aesthetic knowledge
- personalities + approaches to creating relationships with others
- no single way to use aesthetic pattern of knowing
- use your own comfort to develop relationships with others = genuine
- how you as an individual respond to client situation
- reflects your personality + creativity
describe personal knowledge
the knowledge you have about yourself-values, beliefs, biases from your lived experiences
- self knowledge = knowing yourself through self reflection, knowing your biases, beliefs, values, be aware that those might influence the decisions you make as a nurse
describe ethical knowledge
the difference between right or wrong / good or bad
- understand your obligations
- can include following a code of conduct or religion
- not always absolute + the patient + context needs to be considered (CoE)
- knowledge can be developed through experiences, case studies, using decision making frameworks
describe emancipatory: social, economic + political component
recognize social + political problems
- uncovers the root of these issues
- with community can make a change
define evidence informed practice
knowledge is evidence!
define a competent nurse
includes someone who is able to integrate knowledge, skills, and clinical judgement + apply it in practice, ensuring that safe and ethical care is delivered to patients
- a competent nurse is able to demonstrate this knowledge + skills in practice
how can you acknowledge limitations?
- know when to ask for help + support
- taking risks, but not with patient safety
how can you maintain competence?
- an RN who is able to integrate knowledge, skills, + clinical judgement + apply it to practice
- required to ensure the patient receives safe + ethical care
describe nurses + social media
RNs distinguish when digital technology/applications enhance nursing practice + when they breach the practice expectations + CoE
- conduct online + in person would be judged + examined in the same way + held to the same standard
what are social media questions to ask yourself?
- will this post affect my professional reputation or livelihood?
- am I reacting to someone else’s post
- is the information accurate, verifiable + the best available research?
- am I breaching PHIA or any privacy laws?
- what are my reasons for sharing details about my client’s story or image on social media?
does posting something anonymously protect you from professional consequences?
no
define professional practice
focuses on the practice of the nurse + patient safety
- maintain competence + fitness to practice
- duty to report unsafe practice
- RNs must maintain fitness to practice
- RNs must report unsafe behaviours
describe fitness to practice - professional practice
all qualities + capabilities of an individual relevant to their capacity to practice as an RN
- capacity to practice as an RN + consider many aspects of a person - maintaining our own health + abilities to practice safety
- cognitive
- physical
- psychological
- emotional
- not dependent on alcohol, drugs, or other substances that impair their ability to practice
ensure you have capacity in ALL areas so you can provide safe care to patients
- making sure your working standards will keep you safe
describe duty to report - professional practice
RNs have an ethical + legal duty to report unsafe, incompetent, or unethical practice
- assist in maintaining trust with the public
- concerns about an individual or work environment
- making sure public + environment is safe
- identify + share concerns about the safety of another providers practice
when should you report a duty?
- believe another professional is under the influence of drugs/alcohol
- breeched confidentiality
- falsifies information
- abuse to a patient / coworker
- poor orientation / preparation
- conflict between others
- lack of resources / staff
what are the phases of the therapeutic (nurse-patient) relationship
1.pre interaction phase: RN aware of own personal feelings, fears, + worries about working with a patient
2. orientation phase: first meet patient and set goals, build trust + respect
3. working phase: solutions explored, tried + evaluated
4. termination phase: final phase, goals assessed, relationship ends
what is a therapeutic relationship
planned + goal oriented professional relationship is established between the nurse + the patient with the purpose of assisting the client to meet their needs
what characteristics are involved in a therapeutic relationship?
- empathy: implies feeling with a person rather than feeling sorry for a patient (attempt to understand ones pov)
- unequal power: nurse holds more power than the client + that’s always present
- respect + trust: nurse must respect the clients choices (even if they do not agree with them)
boundaries of therapeutic relationships
professional:
- regulated by SoP (standard of practice) + goal directed
personal
- guided by personal values + beliefs + pleasure + interest directed
communication is a two fold by:
- means + way we establish a therapeutic relationship with our patients
- it is the way we (RNs + students) articulate the role we do
describe communication with verbal words
- spoken or written words (only 7% of meaning transmitted through verbal communication) + includes pacing, tone, + timing
- be aware of choice of vocabulary
- meaning - be clear and get point across
- pacing - not talking too fast
- intonation - tone of voice
- timing - do not ask for a favour when they have had a bad day
describe communication with non verbal words
- 93% of meaning transmitted through nonverbal communication
- any communication not including spoken or written words (requires you to use your senses)
- often unconsciously motivated
- we “hear” the non verbal
- personal appearance
- posture - gait (pick up on someones boredom)
- facial expression
- eye contact
- gestures
- sounds
professional communication - relational practice competencies
- authenticity = be genuine + true to yourself
- self awareness = ability to be aware + reflective of ones thoughts, feelings, attitudes, attributes, + actions
- courtesy = saying hi and bye when we encounter patient
- active listening = communication technique requiring nurse to be present physically + emotionally by listening to patient
- empathy + trust = fundamental professional communication skill
- self-disclosure + confidentiality = self disclosure is not recommended unless beneficial
what are non professional communication or non therapeutic communication
- giving personal opinion + self disclosure
- changing the subject (demonstrates lack of empathy)
- false assurance - offering hope + reassurance not founded on facts (avoid saying “don’t worry” or “everything is fine” especially if its not)
- sympathy = feeling sorry for someone may be a compassionate response but it is not therapeutic
define empathy
feeling with a person rather than feeling sorry for them
terms of endearment
using a patients name can give them a sense of dignity (mrs, ms, mr)
avoid terms of endearment - doesn’t show dignity + do not show professionalism
3 parts of collaborative care
- intraprofessional team
- interprofessional team
- collaboration
define intraprofessional team
communication within one profession - team of nurses / nursing students
define interprofessional team
communication with other professions (nurses, HCA, doctor, patient, family) - team of healthcare providers
define collaboration
process of working together towards a common goal (to benefit patient)
describe ethical practice
- practice in accordance with CoE
- protect personal health information (confidentiality)
Canadian nurse association CoE
- primary nursing values
- providing safe, compassionate, competent + ethical care
- promote health + well being
- promote + respect informed decision making
- perserving dignity
- maintaining privacy + confidentiality
- promote justice
- being accountable
ethical practice - harm reduction
- an approach to provide healthcare
- it reduces the adverse health, social, + economic consequences of at risk activities
- emphasizes human rights + importance of treating all people with dignity, respect, + compassion
define confidentiality
healthcare providers are legally + ethically obligated to keep info about clients confidential (duty to maintain privacy)
- nurses have access to all types of personal health info including: conversations, charts (paper + electronic), diagnostic results
define PHIA
- ensures clients have access to their personal health info + ensures the clients personal health info stays private
