Exam Review Flashcards
inductive reasoning
specific observations to reach a general conclusion
based on what is observed
eg. I had fewer kids at my house for halloween this year
deductive reasoning
generalizations to specific conclusions
deriving of a conclusion by reasoning
general idea to reach a specific conclusion
eg. halloween and trick or treating is less popular than it used to be
Questioning
- one method that fosters critical thinking
- sometimes questions are more important than answers
common thought process
- reasoning processes are helpful to solve problems, make decisions, or gain deeper understanding about a particular topic of interest
- decision making
- rationalization
- making inferences
from knowing to being
- illustrates a connection between knowledge and knowing, critical thinking, and the application of thinking and knowing the role of a nurse
- transforms knowledge to understanding
developing critical thinking: internal approaches
- reflecting on values, such as individuality, fun, justice, knowledge, assumptions
- thinking “inside the box”
developing critical thinking: external processes
- engage in critical questioning (promote understanding of multiple perspectives)
- writing to develop and communicate thought
- active engagement in a problem
- generation of ideas
levels of critical thinking
- basic critical thinking
- complex critical thinking
- commitment
basic critical thinking
the learner trusts that experts have the right answers for every problem. thinking is concrete
complex critical thinking
- separate your thinking from authorities and begin to analyze and examine your own choices independently
- willingness to consider other options or explanations
commitment
anticipate the need to make choices without assistance and assume the responsibility for those choices
using research to inform thinking and action
- evidence informed practice
- evaluating sources of evidence
- reading critically
- applying thinking to practice
reflection
- considering key elements of a situation
- asking questions about what factors led to particular outcomes (thinking upstream)
- considering what different types of actions to take in the future
reflexivity
- considering and questioning the assumptions and values that motivate us and inform our practice
- consider our own biases, power, motivation, etc.
- why we do what we do
- how can we do things better
reflection questions
- what? - what happened
- so what? what motivated? how could things have been different?
- now what? - what would you do in the future?
Brenner’s 7 Domains of Competence
1) the helping role
2) the teaching or coaching function
3) the diagnostic monitoring function
4) effective management of rapidly changing situations
5) administering and monitoring therapeutic interventions
6) monitoring and ensuring the quality of healthcare practices
7) organizational and work role competencies
(Heidi Took Demi Eating At My Outpost)
Brenner’s 5 stages of expertise
- the novice
- the advanced beginner
- the competent practitioner
- the proficient practitioner
- the expert
minifism
minimizing the size, severity, or significance or a particular event
discourse privatization
speak quietly and privately to clients about private matters
dimensions of the art of nursing (the 5 senses of nursing)
- the ability to group meaning in client encounters
- the ability to establish a meaningful connection with the client
- the ability to skillfully perform nursing activities
- the ability to rationally determine an appropriate course of nursing action
- the ability to morally conduct one’s practice
Approaches to healthcare
- medical
- behavioural
- socio environmental
approaches to healthcare: medical (early/mid 20th century)
- focus on curing
- heavy reliance on physicians (hospital) care
- no focus on prevention
- payment was out of pocket until the 1960’s
- Tommy Douglas
approaches to care behavioural
- 1970’s - shift away from the medical model approach to behavioural perspective
- understanding health vs just disease
Lalonde Report
- promoted individual responsibility for health
- integration of health promotion and disease prevention
- SDOH first introduced (environment, biology, health care organization, access to care
- criticized for suggesting individuals were to blame for their poor health
- didn’t recognize socio-economic barriers to making healthy lifestyle choices
Epp Report
- expanded the Lalonde report
- shift from lifestyle to environmental determinants
- assess health status of disadvantaged groups
- identify preventable diseases
Ottawa Charter for Health Promotion
- based on Lalonde report
- renamed lalonde’s 4 health fields as “health prerequisites” and expanded to include peace, shelter, education, food, income, stable ecosystem, social justice, and equity
health promotion actions mean to:
- build healthy public policy
- create supportive environments
- strengthen community action
- develop personal skills
- reorient health care services to meet the needs of individuals/communities
approaches to health: socio environmental
- understanding SDOH
- builds on behavioural approach
- acknowledges that health is self defined
SDOH
non medical factors that influence health outcomes
conditions in which people are born, grow, work, live, and age
Canada Health Act
protect, promote, and restore the physical and mental well being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers
federal legislation
governs how provinces receive federal funding
guarantees access to essential medical services
5 pillars of Canada Health Act
- public administration
- comprehensiveness
- university
- portability
- accessibility
public administration
every province must administer and operate a not for profit health care system
comprehensiveness
- must cover all insured services (OHIP)
- all servcies available under the insurance plan must be available to all residents with equal opportunity
university
all insured residents are entitled to the same insured health services (equitable)
portability
residents moving/traveling from one province to another continue to be covered
accessibility
protects from extra charges for health care or discrimination
province provides guaranteed reasonable access to insured services
points of care
- primary
- secondary
- tertiary
primary
- ranges of services and supports to promote health and well being
- Dr/NP office, public health, community rehab, clinic
secondary
- focus on diagnosis and treatment of health
- specialized
- referral based
- physician specialist (dermatologist)
tertiary
- specialized care involving dedicated supports based on referrals
- highly technical
- acute care (hospital)
primary health care reform
- shift to team based/inter-professional care
- shift to health promotion and prevention
- virtual medicine
secondary healthcare reform
- restructuring of hospitals
- electronic health records
- from from institutional to community based
branches of law
public law
- criminal law
- people + government
- federal government
Private law
- civil law
- people + people
- contract law/tort law
- tort=injury person suffers from someone else’s actions
- nurse client relationship
avoid negligence
- provide competent care
- follow practice standards
- advocate for safe staffing ratios
- communicate
- documentation
The Personal Health Information Protection Act (PHIPA)
- information privacy
- rules for management of personal health information
- permits the sharing of health information among the healthcare team
CNO Practice Standard: Code of Conduct
1) Nurses respect the dignity of patients and treat them as individuals
2) Nurses work together to promote patient well-being
3) Nurses maintain patients’ trust by providing safe and competent care
4) Nurses work respectfully with colleagues to best meet patients’ needs
5) Nurses act with integrity to maintain patients’ trust
6) Nurses maintain public confidence in the nursing profession
if a client is harmed, the following will be involved in the reporting process
- student
- instructor (possible RN preceptor)
- hospital/institution
- school (LU)
Indigenous Groups
- indian
- inuit
- metis
indian act
- allows the federal government control over Indian status, land, resources, wills, education, and band administration
treaties
alliances that established relationships and were used long before europeans arrived
- establish peace, regulate trade, share land and resources
colonization
- intended to remove indigenous people from their land, suppress nations, and governments, undermine culture
- Indian act, residential schools, relocation of communities, reserve policies
assimilation
- aggressive cultural domination
residential schools
- first ones opened in 1620’s
- officially began in 1879
- last one closed in 1996
sixties scoop
- 1960’s government removed indigenous children from their homes and fostered them to non-indigenous families
kitmakisowin
cree word describing the effects of colonization
5 areas of kitmakisowin
- Poverty due to marginalization
- Poverty of understanding due to poor education
- Poverty of affection due to lack of support and recognition
- Poverty of subsistence due to inadequate resources
- Poverty of identity due to alien values and beliefs
(Peter Uses Arthurs Socks Inside)
strengths of indigenous people
- resistance
- resilience
- reclaiming
visible minority
people living in Canada who are non-caucasian in race or non-white in colour and who are not indigenous
diversity
differences among people reflecting many traits such as gender, age, language, socvioeconmics, status, disabilities, country of origin, and group affiliation
ethnicity
groups that have a shared cultural identity based on heritage, language, religious beliefs, and values
race
socially created categories of people based on skin colour or other biologic charactetistics
racicalization
The social process that constructs racial categories in ways that label perceived behaviours as having racial origins (=discrimination); consequently results in inequities at social, economic, and political levels and can have direct and indirect effects on health
multiculturalism
cultural and ethnic diversity in Canada; a societal value that encourages preservation and sharing of diversity; emphasizes the freedom of all people to preserve, enhance, and share their cultural heritage
immigrant
someone who is accepted/eligible for permanent residence in another country
permanent resident
a person who has been granted permanent resident status in Canada has been authorized to live and work in Canada indefinitely and has all of the rights guaranteed under the Canadian Charter of Rights and Freedoms, except the right to vote.
3 categories of permanent residents
- economic immigrants
- family class immigrants
- refugees
economic immigrants
People selected for their skills and ability to contribute to Canada’s economy; includes skilled workers, business immigrants, provincial or territorial nominees, caregivers, and the Canadian Experience Class; includes the principal applicant and, where applicable, the accompanying spouse/partner and/or dependants
family class immigrants
People who are sponsored by a Canadian citizen or permanent resident living in Canada who is 18 years of age or older; includes spouses, partners, dependent children, parents, and grandparents
refugees
includes people who have had their refugee claims accepted while in Canada, government assisted refugees who have had their claims accepted outside of Canada, refugee dependents, privately sponsored refugees, and blended sponsorship refugees
temporary residents
authorized to stay in Canada temporarily
- temporary workers (work permit)
- international students (study permit)
- refugee claimants (asylum)
undocumented migrant
not authorized to be in Canada because work or study permit expire or other reasons
migrant
a person who has moved from his or her country or region of origin either temporarily or permanently
citizenship
- Have permanent resident status
- Have lived in canada 3 out of the last 5 years
- Filed taxes for at least 3 out of the 5 years
- Language skills
- Pass a citizenship test
- Other requirements may apply
health inequities
Differences in health that are unfair/unjust
Created by social conditions
differences (positive or negative)
uneven distribution of health or health resources as a result of various factors or the lack of resources
health disparities
Differences in health status among ethnic groups as a consequence of racism
SDOH & Vulnerability: Materialistic explanations
- how SDOH affect health
- income, housing, employment, social support, education
SDOH & Vulnerability: Neo-materialistic explanations
- unequal distribution of resources that impact living and working conditions (eg. lack of affordable housing=homelessness)
SDOH & Vulnerability: Life Course Explanation
- cumulative impact of social and economic conditions on health throughout the lifespan
SDOH & Vulnerability: Psychosocial explanation
- stress associated with uneven distribution of resources in society
intersectionality
- The interconnected nature of social categorizations such as race, class, and gender, regarded as creating overlapping and interdependent systems of discrimination or disadvantage; a theoretical approach based on such a premise
- Exploring intersections of race, gender, and class their impacts on individual well being has important implications for critically examining issues of justice and equity for marginalized populations
vulnerability: role of the nurse
- Advocate for policies that address the SDOH
- Promote capacity and empowerment building with communities and individuals
- Include individuals in the discussions and change
- Use an intersectionality lens in practice (helps nurses attend to power dynamics)
- Use of intersectionality lens in research
spirituality
a highly subjective and ineffable (beyond words) concept that defies standard definition and encompasses the individual’s beliefs; expressions of these beliefs; perceptions of the meaning of life and death; and how the person relates to self, others, the world, and the possibility of a greater power
spiritual practices
processes of inner quieting to help attain a state of calm centeredness and receptive awareness, which nurtures the spirit and deepens insight, attention, and compassion for oneself and others
religion
- an organized way of expressing and nurturing spirituality through affiliations, rites, and rituals based on creeds, code of conduct, or communal practices
- organized system of beliefs regarding the cause, purpose, and nature of the universe that is shared by a group of people, and the practices, behaviors, worship, and ritual associated with that system
worldview
a mental map containing a set of core beliefs and meanings that we use to explain the world around us and guide our way of being in the world
healing
the process of moving towards wholeness in all dimensions of health, encompassing the mental, emotional, physical, relational, cultural, and spiritual; as such, it may or may not be associated with curing disease and disorder
suffering
distress, pain, or anguish, whether physical, mental, emotional, and/or spiritual, which can challenge the very trust we have in life
spiritual care: responsibilities of the nurse
- be attuned to a patient’s spirituality, because it can be apart of their healing
- offer spiritual care
- ethical inquiry and follow up
TRUST - Model for Spiritual Assessment & Care
- traditions
- reconciliation
- understanding
- searching
- teachers
Newman’s Theory of Health as Expanding Consciousness
Newman did not see health and illness at two ends of a continuum, but being integral to the meaning of life, with health and illness both having the capacity to expand consciousness, with the ultimate goal of nursing being to foster higher levels of consciousness.
Consciousness is defined by Newman as information- how and what people know of themselves in the world. As people expand their consciousness and gain knowledge of themselves, they are better able to identify and transform their life patterns.
- becoming more of oneself, finding greater meaning in life, and reaching new dimensions of connectedness with other people and the world
Parts of Newman’s Theory
- identifying patterns
- shifting nursing practice (Shift from viewing pain and disease as negative to a view that pain and disease are information about the life pattern and an opportunity for growth)
- nursing interventions as a relational practice
- moving beyond problems
- entering into the difficulty
- responding to patterns
concept
An idea or notion that represents some aspect of personal/human experience
theory
- Comprises several concepts (sets of concepts) used to describe, explain, or make predictions about a phenomenon (something in the physical and social world)
- Theory suggests relationships within, between, or among concepts
- In nursing, theory informs practice and practice informs, challenges, or confirms theory
4 theoretical assumptions about nursing and healthcare
- The nurse and client relationship is important
- The environment has a direct effect on the client’s well-being
- Environmental factors contribute to good health (fresh air, clean water, cleanliness of client and environment, light exposure)
- A nurse can determine interventions necessary to modify the environment and influence positive client outcomes
Nursing Metaparadigm
Metaparadigm describes a global way a professional discipline looks at the world
- Concept of Person: recipient of holistic nursing care; exist in the context of systems; personal characteristics influencing health choices and healing
- Concept of Health: intended outcome of nursing care; SDOH; across the lifespan
- Concept of Environment: all that affects a person (internal/external context); immediate surroundings; policies to establish and sustain healthy environments
- Concept of Nursing: caring; relational practice; (CNA) Code of Ethics
levels of nursing theory
- grand nursing theories
- midrange theories
- nursing practice theories
grand theories
broad, abstract, cannot be directly tested
midrange theories
- Narrower in scope
- Bridges between grand nursing theories and practice level theories
- Focused enough to guide practice and research; general enough to be used across different client populations and concepts; can be “tested” through research and as evidence to support nursing interventions
nursing practice theories
- For use within specific nursing care situations (practical application)
- Provide a framework for nursing interventions or activities (how to)
- Suggest outcomes or impact of nursing practice (x=y)
Strengths Based Nursing Care Theory
- SBC looks at a person’s or family’s strengths as the unique qualities and resources that comprise their personhood (who they are)
- SBC focuses on individual, family, and community strengths as a foundation for nursing care
- Strengths are needed to meet goals, improve health, restore wholeness, overcome challenges, and improve quality of life
Paterson & Zderad’s Humanistic Theory
- Builds on Pepau’s (1952) work on interpersonal experiences between nurses and patients
- Describe nursing as “an experience lived between human beings” – inspire us to move beyond technical “doing” to ”being”
- Humanistic nursing understands nursing “happens between people” (emphasizes presence, and awareness to a “with-ness” between nurse and patient)
- Nurses needing to be attentively present with people
- Beginning by asking about their experience (how events/ illness transpired, what was meaningful), vs. jumping into telling them what to do next, and what to do next time
Carpers “4 ways of knowing”
- empirics (science of nursing)
- aesthetic (art of nursing)
- personal knowledge (self awareness and self reflection)
- ethics (moral knowledge in nursing)
Chinn & Kramer added a 5th:
- emancipatory knowing - being aware of social problems and taking actions to create social change
praxis
when all 5 knowing patterns come together in a way that supports social justice
“Praxis” requires a nurse to move beyond just practicing (irrigating a wound for ex.) and to engage in processes that undo any social inequities that he or she finds to be present in the healthcare environment.
personal knowing
- Process of self-knowing (authenticity, wholeness, questioning, biases/assumptions, strengths, values)
- Who you are as a person affects your behavior, attitudes, and values both positively and negatively.
- Develops from interactions and relationships
- Process of reflection in order to understand how your feelings may affect your nursing care
ethical knowing
- Ethics in nursing is focused on matters of obligation: what ought to be done.
- The moral component of knowing in nursing goes beyond knowledge of the norms or ethical codes of conduct: it involves making moment-to-moment judgments about what ought to be done, what is good and right, and what is responsible.
- Ethical knowing guides and directs how nurses morally behave, what they value as being important, what is good and right, and how they navigate ethical dilemmas.
- Involves clarifying conflicting values and exploring alternatives
- May be no satisfactory answer to ethical dilemma
- May experience moral distress
Aesthetic Knowing
- appreciation of the meaning of a situation
- connect with human experiences that are unique (sickness)
- “being with”
- grasping the meaning of an encounter
- establishing connections
- therapeutic relationships
- the art of nursing
Empirical ways of knowing
- based on the assumption that what is known is accessible through the physical senses, particularly seeing, touching, and hearing (objective).
- Grounded in science and other empirically based methodologies (logical reasoning/systematic methods including testing hypothesis, generating theory, describing phenomena)
- the science of nursing
Emancipatory Knowing
- the human capacity to be aware of and critically reflect on the social, cultural, and political status quo and to determine how and why it came to be that way
- Emancipatory knowing calls forth action in ways that reduce or eliminate inequality and injustice
- Examining relations of power- dominance, oppression, marginalization, racialization
- identifies barriers that prevent health and well being
knowing
- ways of perceiving and understanding the Self and the world
- knowing is a concept linked to ontology (a way of being) that is grounded in and unique to our individual and personal reality (different for everyone)
