Exam#1 Flashcards
1
Q
Stages of Professional Socialization
A
Stage 1: Excited (to start new role)
Stage 2: Overwhelmed/Doubt (if you can do the new role)
Stage 3: Let go of the LPN role
Stage 4: Accept the new role of the RN
2
Q
Role
A
Set of expectations that will DEFINE the behavior society deems appropriate or inappropriate for the occupation
3
Q
Care Provider
A
Most commonly recognized role, aims to ensure the best possible health for the patient
4
Q
Counselor
A
provide pt/family with guidance and support/ identify emotional needs
5
Q
Educator
A
knowledge provided to the patient/their family/ the community
6
Q
Manager
A
supervises other members, planning, managing, and coordinating care.
Sound decision-making and problem-solving skills
7
Q
Advocate
A
protect pt/family from harm, speak up against harmful or unnecessary forces
“take the patient’s side”/”stand up for the patient” right to autonomy and self-determination
8
Q
Collaborator
A
Team dynamic; working toward common goal or end point.
Multidisciplinary meetings to ensure cooperation and compliance
9
Q
Change Agent
A
Take a risk; possess courage to make change to implement EBP
10
Q
Role Model
A
Code of ethics; present self in manner that best attributes the profession
11
Q
Mentor
A
trusted advisor; promotes growth for others
12
Q
Researcher
A
investigating possible solutions to nursing/patient problems; EBP awareness
13
Q
Entrepreneur
A
function as a consultant, educator, and advisor
14
Q
RN Roles
A
Legally responsible for initiating and carrying out the nursing process; Practices is autonomous; cares for most complex and highest acuity; delegates care; teaching and management; analyze and interprets data; determines nursing diagnosis; establishes patient-centered goals; evaluates patient progress; evaluates effectiveness of interventions
15
Q
RN and LPN Roles
A
assists in developing of nursing care plan; gives direct person care to patients; admin medications and IV fluids; practice is directed; common health problems; practices collaboratively; collects data; identifies deviation from normal
16
Q
3 types of RN education programs
A
Diploma, Associates degree, Baccalaureates degree
17
Q
ANA
A
American Nurses Association; published Nursing scope and standards of Practice
Six standards of practice
Nine standards of professional performance
18
Q
6 Standards of Practice
A
Assessment, Diagnosis, Outcome Identification, Planning; Implementation, Evaluation
19
Q
9 Standards of Practice
A
Quality of Practice, Education, Professional Practice Evaluation, Collegiality, Collaboration, Ethics, Research, Resource Utilization, Leadership
20
Q
3 primary ADN roles
A
Provider of care
Manager of care
Member of the profession
21
Q
4 key elements for the future of Nursing:
A
- Practice to the full extent of education and training
- achieve higher levels of education
- Full partners with physicians and other health care professionals
- effective workforce planning and policy making, with better data collection and information infrastructure
22
Q
Middle Ages
A
Religious Orders
23
Q
Renaissance era
A
Protestant reformation in Europe, moved away from religious orders to SECULAR and STRUCTURED care
formal training programs began
24
Q
Industrial Revolution
A
Women improved nursing education and patient care.
25
Nursing care in the Early 1980's:
cost reduction and quality improvement issues surfaced, MANAGED care emerged.
26
Florence Nightingale
believed nursing care was to put the patient in the best conditions possible for healing; decreased Crimean War death; believed nursing is an art that requires organized, practical, and scientific training
27
Factors influencing Nursing TODAY:
Aging population, Known as "Graying of America"
Health maintenance and disease prevention
Outcomes-oriented patient-centered care*
Cost containment*
Quality Improvement
Patient Protection and Affordable Care Act
28
Outcomes-oriented patient-centered care
work with population and individuals to develop health related goals; achieve positive experiences with minimal complications
29
Types of Cost Containment groups:
DRG- Diagnosis-related groups (pre-Tx Dx billing)
PPO- Preferred provider organization (discounts w/ specific Dr's)
HMO- Health maintenance organizations (prepaid fee)
Medicare (state program for ppl >65 or disability)
Medicaid (federal assistance for financial needs, below poverty)
30
Quality Improvement
continuous; uses clinical care pathways or care paths.
Joint Commission est. core measures for disease process
CMS (medicare/medicaid) est. Hospital Quality Initiatives for EBP
Leap Group collects/reports safety/quality data to the public & payers
31
Patient Protection and Affordable Care Act
Grants for Master & Doctoral studies; aims to increase nursing knowledge in quality standards, assessment, and improvement
1.5 billion in maternal/child programs
32
Law
mandates how we MUST behave toward each other
33
Ethics
How we SHOULD behave
34
Common Law
aka Case law, judge made decisions
35
Administrative Law
controls the administrative operations of government
36
Statutory Law
Constitutional Law & Enacted law- ie: nurse practice act
37
Legal Principles
Confidentiality and the right to privacy- HIPAA
38
Patient Rights
to be treated with dignity and respect, privacy, decision-making, confidentiality, access to health records, and the right to refuse treatment
39
Informed Consent
patients must fully understand what he or she has consented to for the consent to be valid
40
Assault
Deliberate THREAT to physically harm another
41
Battery
ACTUAL or intentional ACT of touching another WITHOUT consent
42
False Imprisonment
Verbal or physical forcing an individual to stay in a place against their wishes
43
Negligence
failure to use care as a reasonably prudent and careful person would under similar circumstances
44
Professional Negligence
omission or commission of an act that departs the standards of care
45
Accountability
willingness to assume responsibility and accept the consequences for your actions
46
Tort
legal wrong committed against a person or property
| Unintentional tort- professional negligence
47
Malpractice
improper or unethical conduct or unreasonable lack of skill by a professional; four elements must be present: Duty of care, Breach of Duty, Injury, and Causation
48
Duty of Care
obligation to a recognized standard of care
49
Breach of Duty
a failure to adhere to an obligation and a deviation from standards of care
50
Injury
Actual damages have occured
51
Causation
injury was foreseeable, caused by a breach of duty, and the conduct was the cause of the injury
52
Guidelines to prevent negligence and malpractice
Perform only skills within your scope, stay current in your field, delegate carefully and legally, admin drugs using the 6 rights, be aware of strengths and weaknesses, and advocating for your patients
53
High Risk areas for Malpractice
Medication administration
ED
Mental Health
Specialty areas
54
Most Common Malpractice Claims against nurses
Failure to: follow standards of care, use equipment in a responsible manner, communicate, document, assess and monitor, act as a patient advocate
55
Failure to Rescue
lack of a timely and appropriate response to changes in a patient's condition
56
Root-Cause Analysis
designed to seek errors of process, rather than lay blame on individuals or groups
57
Mandatory Reporting
Child abuse and neglect & elder abuse and neglect
| Report to Child/Adult protective services
58
Bioethics
applies ethical theories and principles to moral issues and problems in the practice of medicine
59
Morals
what we believe to be right and wrong, based on religious beliefs, culture, social influences, and life experiences
60
Values
beliefs and ideals, shaped by one's culture
61
Moral development
how an individual learns to handle moral and ethical dilemmas
62
Autonomy
freedom to make own decisions, self determination
63
Veracity
truth-telling
64
Fidelity
practicing faithfully within legal boundaries; keeping promises
65
Beneficence
promoting/doing good
66
Nonmaleficence
Do NO harm
67
confidentiality
protection of private health information, right to privacy
68
Justice
fairness
69
Culturally Competent Nursing care
integration of knowledge, attitudes, and skills- the ability to work within the cultural context of individual, family, or community
70
Ethical Dilemmas exist when...
a conflict arises among health care professionals, patients, families, and health care organizations
71
Moral Courage
deciding on a right course of action regardless of possible consequences
72
Moral Distress
Situations in which an individual knows the right action to take BUT feels powerless to take that action
73
8 steps to Ethical Decision-Making
1. gather relevant information
2. stating the practical problem
3. Identify ethical issues and questions
4. select ethical principles and theoretical frameworks to consider
5. conducting an analysis and prepare a justification
6. consider one or more counterarguments
7. exploring the options for action
8. selecting, completing, and evaluating the action
74
Skill level of nurse:
Novice: beginner, lacks experience, does exactly as told
Advanced beginner: gains experience, level of most graduates
Competent nurse: 2-3 yrs in new role, organizational skills
Proficient nurse: much experienced, thinks holistically and critically
Expert nurse: great deal of experience, flexible and adaptable
75
National Quality Forum
Created NEVER EVENTS in 6 areas: surgical, product/device, patient protection, care management, environmental, and criminal.
76
Quality and Safety Education for Nurses (QSEN)
ensures that all nurses develop knowledge, skills, and attitudes for continuous quality and safety improvement
77
Personal Accountability
maintain level of expertise, make honest assessment of weakness and strengths
78
practice question #1: the nurse correctly understands the nine standards of professional performance?
collegiality
79
practice question #2: florence Nightingale is known as:
the lady with the lamp
80
practice question #3: DRGs, PPOs, HMOs, what nursing concept is the nurse describing?
Cost Containment
81
practice question #4: a patient is trying to leave the hospital but the nurse restrained him to the bed, what action did the nurse commit?
False imprisionment
82
practice question #5: a nurse wants to give immunizations to everyone because they provide the most good for the greatest amount of people, which ethical theory is the nurse using?
utilitarianism- actions judged on the greatest good
83
practice questions #6: which organization is responsible for defining the standards of practice?
Individual state boards of nursing
| i.e. Colorado
84
Lydia E. Hall 1955
Introduced observation, administration of care, and validation.
85
1958-1961 Orlando
3 step nursing process: assessment, planning, and evaluation.
86
1973 the ANA added:
Diagnosis, to the nursing process
87
1991 the ANA introduced:
outcome identification
88
6 step nursing process:
assessment, diagnosis, outcome identification, planning, implementation, and evaluation.
89
Assessment
objective and subjective data; complete head to toe
pain is subjective, but always what the patient says it is
can collect from primary (pt) and secondary (family) sources
validate all assessment info.
90
Diagnosis
may be actual, potential, or wellness; written using PES format (Problem, etiology, and S/Sx)
Etiology is related to .... S/Sx is as evidenced by ....
collaborative problems for whole team dynamic
Dx arranged by priority, using Maslow's hierarchy of needs
Safety is a priority
91
Outcome Identification
immediate, intermediate, and long-term goals
MUST be specific, realistic, and measurable (SMART goals)
Nursing Outcome Classification (NOC)*
92
Nursing Outcome Classification (NOC) has 31 classes and 7 domains, teh 7 domains are as follows:
1. functional
2. physiological
3. psychological
4. health knowledge and behavior
5. perceived
6. Family
7. community
93
Planning
goals and outcomes and planning interventions, regain a level of independence, establish outcome priority
Use linear or concept maps
Nursing Interventions Classifications (NIC)*
94
Nursing Interventions Classifications (NIC) grouped into 30 classes and 7 domains, in 4 basic categories:
Basic; physiological; behavioral
Safety
Family; community
Health systems
95
Implementation
Carrying out the plan of care; multidisciplinary approach
96
Evaluation
process of examining the effectiveness of the plan; evaluation occurs simultaneously and continually
may require altering the care plan to meet the patient's needs
97
Critical thinking
purposeful and rational; accomplishes a specific goal
| MUST understand and be incorporated into practice
98
critical thinking; think RED
Recognize assumptions
Evaluate arguments
Draw conclusions
99
purpose of critical thinking
to ensure that the decision-making process will lead to the best possible patient outcomes
100
purpose of critical thought and reasoning
recognizes the question "what are you trying to accomplish"; define the purpose clearly and accurately
Point of view- explains or illustrates how the data can be understood
Critical thought is fluid and circular
101
Attributes of a critical thinker....
```
curiosity (attention to details)
pursuit of information (to know more)
rational thoughts
reflection (looking back)
creativity (thinking outside of the box)
intuition (listening with your 6th sense)
```
102
The process of critical thought:
is rooted in discipline, exemplified by clarity, accuracy, specificity, relevance, logic, consistency, depth, and significance.
BE THE DR's EYE and PATIENT ADVOCATE
103
Verbal vs. nonverbal communication
verbal: spoken (10% of communication)
non-verbal: is processed through tone, pitch, intensity of how we speak, body language, facial expressions, personal appearance.... how we listen, use silence, use touch, and use space. (70-90% of communication)
104
therapeutic communication:
occurs when a nurse engages in a helping relationship with a patient and family
Requires: empathy, genuineness, positive regard, self-awareness, and non-judgmental
105
empathy
the ability to perceive the patient's needs, feelings, and situation
106
genuineness
the ability to meet person to person in a therapeutic relationship
107
Positive Regard
implies respect and willingness to work with the patient and communicate that the person is worthy of caring about
108
self-awareness
recognition of one's own feelings
109
non-judgmental
not judging one's values or decisions
110
Nurse-patient relatiionship
a planned and goal-directed process that focuses on the patient's feelings, problems, and needs.
3 Phases*
111
3 Phases of the nurse-patient relationship
Orientation/introductory phase- intro, set goals, orient pt/family to the facility
Working phase- longest phase, assess, interview, lasts until discharge
Termination phase- final phase, goals met, understanding verbalized, psych situation
112
Health Literacy
an indivduals ability to gain understanding and use of information to promote and maintain health
113
Culture
beliefs, values, and learning patterns of behavior to guide actions and decision-making
114
Cultural Competence
ability to provide diverse cultural care; self-awareness of conflicting feelings
Aware of non-verbal communication, different for each culture
115
Older adults
need special accommodations for changing systems... ie: hearing, vision, etc.
116
collaborative communication
refers to interactions and functioning among patients and the healthcare team to provide safe, patient-centered, quality care
Assertive, aggressive, or passive-aggressive communication
Use of SBAR (situation, background, assessment, recommendations)
117
practice question #7: what is subjective data?
the patient reports nausea.
118
practice question #8: a nurse is developing an individual care plan for a patient, which of step of the nursing process is she using?
planning
119
practice question #9: after gathering data from the assessment and identifying needs, the nurse develops a care plan. She is demonstrating which type of reasoning?
deductive
120
practice question #10: a nurse is in the working phase with a patient and is using therapeutic communication, what statement will facilitate interactions?
It must be hard to tell me how you are feeling
121
a nurse communicates using the SBAR, what section is the "A"
assessment
