Exam 1. Ch 1, 16, 17 Flashcards
Nursing is an..
Art- Learn to deliver care w compassion, caring, & respect for each pt’s dignity and individuality
Science- Nursing practice is based on body of knowledge and evidence based practice that are continually changing w new discoveries and innovations
Nursing practice requires…
A blend of current knowledge and practice standards with an insightful and compassionate approach to each pt’s needs.
Nursing as a profession includes
Pt centered care- individuals, families, & or communities
Professionalism- administering quality care, as well as being responsible and accountable
Characteristics of a quality nurse
- Has current knowledge of practice standards
- Is insightful and compassionate
- has critical thinking skills
Benners stages of nursing proficiency:
NOVICE- Nursing students; nurse entering a position with no experience
ADVANCED BEGINNER- some level of experience
COMPETENT- 2-3yrs of same clinical experience
PROFICIENT- more than 2/3yrs of experience in same clinical position
EXPERT- Diverse experience; takes time & commitment to become an expert
Goal of standards of nursing practice
To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards of practice
ANA six standards of practice:
- Assessment
- Diagnosis
- Outcome Identification
- Planning
- Implementation
- Evaluation
ADOPIE
The nursing practice is the…
Foundation of clinical decision making
Professional roles and responsibilities of nurses
- Autonomy
- Accountability
- Caregiver
- Advocate
- Educator
- Communicator
- Manager
The nursing career provides…
An opportunity to commit to lifelong learning and career development
Career development is
Innovations in healthcare, expanding healthcare systems and practice settings, and the increasing needs of pt’s have created new nursing roles
Oppertunities in the nursing field..
Are limitless.!
Advanced practice RN (APRN)
- The most independently functioning nurse
- Has a masters or DNP degree in nursing
- Functions within their area of practice to plan or improve the quality of nursing care for Pt’s and their families
Clinical nurse specialist
APRN who is an expert clinician in a specialized area of practice
Nurse practitioner
APRN who provides comprehensive healthcare to a group of pt’s in an inpatient, outpatient, ambulatory care, or community based setting
Certified nurse midwife
APRN educated in midwifery focusing care on full range of primary healthcare services for women from adolescence to menopause
Certified nurse anesthetist
APRN with advanced education from a nurse anesthesia accredited program. Must have 1 yr of critical care or ER experience. Works under the guidance of anesthesiologist or a physician w an advanced knowledge in surgical anesthesia
Nurse educator
Works primarily in schools of nursing or staff development departments of healthcare agencies
Nurse administrator
Manages Pt care and the delivery of specific nursing services within a healthcare agency
Nurse researcher
Conducts evidence based practice and research to improve nursing care and further define and expand the scope of nursing practice
Essential skills of nursing:
- Time management
- Theraputic communication
- Patient education
- Compassionate implementation of bedside skills
Knowledge of the history of nursing increases…
Your ability to understand the social and Intellectual origins of the discipline
Florence nightingale
- “Mother” of modern nursing
- First practicing epidemiologist
- Organized first school of nursing
- Improved sanitation in battlefield hospitals
- Known as “lady with the lamp”
- Practices remain a basic part of nursing today
- States that pt outcome can be directly related to environment
Clara Barton
Founder of the red cross
Mother Bickerdyke
- Organized ambulance services
- Walked battlefields at night looking for wounded soldiers
Harriet Tubman
Prominent female in the Underground Railroad movement, helped to free slaves
Mary Mahoney
- First professionally trained african American nurse
- Brought forth awareness of cultural diversity
Lillian Wald & Mary Brewster
- Opened Henry Street Settlement
- Nurses working in HSS were some of the first to demonstrate autonomy in their practice
20th century nursing changes
- Movement toward developing a scientific, research-based practice and body of knowledge
- Nurses assumed advanced practice roles
21st century changes in nursing
- Changes in nursing school curriculum
- Advances in technology and informatics
-New program’s address current health concerns
(Focuses on supporting nursing scholars, decrease nurse shortage, improve health of nations population)
-Nursing is taking leadership roles in developing standards and policies
Importance of nurses’ self-care
Compassion fatigue can occur as well as secondary traumatic stress, and burnout
Healthcare reform influencing nursing
Affecting how healthcare is paid for and delivered. More nursing in community-based settings
Rising healthcare costs influencing nursing
Presents challenges to nursing profession, consumer, and healthcare delivery system
Demographic changes influencing nursing
Movement of people from rural to urban areas, increased life spans, increase in pt’s living w chronic, and long-term illnesses
Medically underserved influencing nursing
Unemployment, low-paying jobs, mental illness, homelessness
Trends in nursing
-There continues to be an increasing awareness for pt safety in all healthcare settings
- Evidence based practice
- Quality and safety education for nurses
- Genomics
- Public perception of nursing
Nursing is a dynamic profession that..
Grows and evolves as society and lifestyles change, as healthcare priorities change, as technologies change, and as nurses themselves change
Professional registered nurse education
RN EDU:
2 year associates degree/4 year baccalaureate degree
National council licensure exam for RN’s (NCLEX-RN) in your state
GRADUATE EDU:
Master’s degree, APRN
Doctoral degrees
Continuing education (ECU’s) and in-service edu
Nurse Practice Act
Regulates scope of nursing practice for the state and protects public health, safety, and welfare
- Overseen by state boards of nursing
- Protects public from unqualified and unsafe
Licensure and certification
After passing the NCLEX nurses can choose to become certified in a specific area of nursing practice
EX: MedSurg, ICU, ER…
Professional nursing organizations
- Address member concerns
- Present educational programs
- Publish journals
- Seen to improve standards of practice, expand nursing roles, and foster welfare of nurses within the specialty area
Nursing organizations include:
- National league for nursing (NLN)
- American nurses association (ANA)
- International council of nursing (ICN)
Assessment involves…
Collecting info from the pt and from secondary sources, along w interpreting and validating the info to form a complete database
What are secondary sources.?
Family members, friends, etc.
Two stages of assessment
- Collection & verification of data
- Analysis of data
Sources of data:
- The patient
- Family & SO’s
- Healthcare team
- Medical records
- Scientific literature
PT “database”
All info obtained from pt goes into a “Database”. These include percieved needs, health issues, and responses to problems
What does the nurse NOT document.?
Subjective descriptions, if pt has stated something record it in quotations
EX: my left arm hurts= “pt states My left arm hurts”
What can you do with subjective data.?
You can infer info from subjective data
EX: PT expresses fear of surgery and dying. Vitals are stable.
Always ask pt why they feel the way they feel to try and provide edu to the pt regarding their fears
Types of assessments
-PT centered interview
-Physical assessment
-Periodic assessments (Rounding)
-Comprehensive pt history
•general to specific
•problem oriented
Critical thinking skills allows the nurse to…
Synthesize relevant info and use it in a purposeful way
CUE: info obtained by use of senses
INFERENCE: nurses judgment or interpretation of cues
Motivational interviewing
Often used in counseling
Effective communication
Requires courtesy, comfort, connection, and confirmation
When prepping for PT interview the nurse should…
Always be prepared.!
Orientation phase & setting agenda
Nurse is introducing self, position, and purpose of interview
Working phase
Asking Q’s, listening, and gathering info
Termination phase
Summarizes discussion and checks for accuracy.
Interview techniques
- Observation
- Asking open-ended Q’s
-Leading Q’s; can be risky & limit info to what the pt thinks you want to hear/know
- Back channeling
- Direct closed-ended Q’s; limits info to yes’s & no’s
Cultural considerations when engaging patients
- Must consider pt’s cultural background to get a complete & accurate assessment
- Respect unfamiliar beliefs, and be sensitive to pt uniqueness
- If unsure of what pt is saying, ask for clarification to prevent making wrong diagnostic conclusions
Components of health history
- Biographical info
- Reason for seeking care
- Health history
- Psychosocial history
- PT expectations
- Present illness or health concerns
- Family history
- Spiritual health
- Review of systems
Biographical information
- Age
- Address
- Occupation
- Marital status
- Insurance
Health history
Provides nurse w info about pt family history: data about immediate and blood relatives which determines the risks of a genetic or familial nature
Psychosocial history
Support system.? Spouse.? children.? Friends.?
Review of systems (ROS)
Systemic approach for collecting objective & subjective data from pt about problems in each body system
Data validation
- Compare findings w othe sources for accuracy
- Can lead the nurse to reassess or gather additional info
Important aspect of nursing observations
Includes pt level of function: -Physical -Developmental -Psychological -Social Rgarding aspects of everyday living
What is a care plan.?
A pt plan that provides:
- Direction for individualized care of pt
- Flows from each pt’s unique assessment and organized by pt specific needs
-Means of communication and organizing actions of constantly changing nursing staff.
(As needs are met care plan changes)
Components of a care plan:
- Pt database
- Interviewing
- Physical assessment
- Diagnostic studies
(Must complete a thorough assessment of pt and their issues to create a care plan)
Pieces of the care plan
-What is the area of concern that the nurse can treat/prevent/monitor.?
(Diagnosis)
- What is an appropriate GOAL for the pt.? (Goal/Outcome)
- What TREATMENT is most effective.? (Intervention
Nursing Diagnosis
- With assessment data, the nurse identifies a disgnosis for the pt
- A clinical judgement about actual, or potential individual, family, or community experiences
- Can be a pt response to health issues or life processes
- Drives interventions & pt outcomes
- Allows for continuous data collection & improvements in pt care
Medical diagnosis
Deals w a specific disease or medical condition
EX: stroke, diabetes, Asthma
Nursing diagnosis
Deals w human response to actual or potential health problems & life processes
EX: Impaired verbal communication, nutritional imbalance
Regarding diagnosis, what is the nurse NOT to do.?
Use a medical diagnosis anywhere in the nursing diagnosis
Nursing diagnosis
- More holistic understanding of impact of a condition on the pt & their family
- Distinguishes nurses role from physicians
- Helps nurses focus on nurse scope of practice
- Fosters development of nursing knowledge
- Provides info that gives all members of the healthcare team a common language or understanding pt needs
NANDA-I stands for
North American Nursing Diagnosis Organization- International
NANDA-I is responsible for…
- Creating approved, standardized, nursing diagnoses
- Diagnoses communicate professional judgements nurses make
NANDA-I can be used for…
Creating care plans
Can be found in nursing care plan books
The diagnosis process requires…
The use of critical thinking.!
- Helps to be thorough, comprehensive, and accurate when identifying nursing disgnoses that apply to the pt
- diagnostic reasoning process involves using assessment data gathered about pt to logically explain a clinical judgment or nursing diagnosis
Actual nursing diagnosis (Problem focused)
Describes human responses to health conditions or life processes
Risk nursing diagnosis
Describes human responses to health conditions/life processes that MAY develop in a vulnerable pt
Health promotion diagnosis
A clinical judgment of motivation, desire, and readiness to enhance wellbeing and actualize human health potential
Actual nursing diagnosis describes:
- Etiology (related to) NOT medical diagnosis so NO PATHOS
- Can be an underlying condition, what is occurring in the body to cause the specific nursing diagnosis.?
-S/S (As evidenced by)
•data collected, S/S, assessment pieces
•needs at least 3 pieces in diagnosis
Example of an actual nursing diagnosis:
PROBLEM related to ETIOLOGY as evidenced by S/S
IMPAIRED GAS EXCHANGE related to DECREASED BRONCHIAL AIRFLOW as evidenced by LABORED BREATHING, RESPIRATIONS OF 24, and PULSE OX READING OF 91%
Risk for nursing diagnosis describes:
-Potential problem thats approved by NANDA-I
EX: Risk for infection
- No etiology as it is not an actual problem yet
- S/S (As evidenced by), requires at least 3 pieces of evidence to the potential problem
- Evidence must show why you believe it is a potential problem
Example of Risk for diagnosis …
POTENTIAL PROBLEM as evidenced by 3 S/S
Risk for FALLS as evidenced by UNSTEADY SHUFFLING GAIT, USE OF FURNITURE FOR SUPPORT WHILE AMBULATING, and PT COMPLAINS OF GENERALIZED WEAKNESS
Readiness for diagnosis describes:
- Potential health promotion approved by NANDA-I. Usually written as “Readiness for…”
- S/S; Evidence that suggests a potential for health promotion
Readiness for diagnosis example:
Readiness for ENHANCED SELF-CARE as evidenced by EXPRESSED DESIRE TO ENHANCE SELF-CARE
Common NANDA-I Diagnoses:
- Acute pain
- Activity intolerance
- Anxiety
- Impaired gas exchange
- Impaired skin integrity
- Impaired physical mobility
- Decreased cardiac output
- Deficient fluid volume
When prioritizing diagnoses…
Highest priority goes first.!
- ABC’s are always first
- Maslows hierarchy is next
- “Risk” diagnoses are not a priority
Classification of priorities:
HIGH: Emergent, life-threatening
INTERMEDIATE: non-life-threatening
LOW: affect pt future well being (Risk for & health promotion diagnoses)
PES format stands for
Problem, Etiology, S/S
Changes in POC are needed when…
The pt assessment has changes; diagnosis needs to be changed as well.
-If pt has change in presentation, first assess then determine new nursing diagnosis.
