Funda prelims Flashcards
Learning to deliver care with compassion, caring and respect for patient dignity and individuality
Art
Based on body of knowledge and evidence-based practices that are continually changing
Science
The patient is the center of the nursing practice - individuals, families or communities
Nursing as a profession
True or False:
Nursing is simply a collection of specific skills and a nurse is simply a person trained to perform specific tasks
False:
Nursing is not simply a collection of specific skills and a nurse is not simply a person trained
to perform specific tasks
According to who:
Nursing incorporates the art and science of caring and focuses on the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence
Ana 2021
According to who:
Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. Nursing includes the promotion of health; prevention of illness; and the care of ill, disabled, and dying people
ICN 2021
Scope of Nursing - a person shall be deemed to be practicing nursing within the meaning of ___ when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy,
childhood, adulthood and old age. As member independent practitioners, nurses are
primarily responsible for the promotion of health and prevention of illness. As
members of the health team, nurses shall collaborate with other health care providers for
the curative, preventive, and rehabilitative aspects of cares, restoration of health,
alleviation of suffering, and when recovery is not possible, towards a peaceful death.
RA no 9172, 2002 Article 6: Nursing practice and PRC Board Resolution no.425, 2003
What are the 5 duties of the nurse?
- Provide nursing care through the utilization of the nursing process
- Establish linkages with community resources and coordination with health term
- Provide health education
- Teach, guide and supervise students in nursing education programs, undertake consultation services, engage in activities that require the utilization of knowledge and decision-making skills
- Undertake nursing and health human resource development training and research to include development of advance nursing practice
What is the 2 scopes of nursing?
- Observe the code of ethics and uphold standards of practice
- Continual learning through continuing professional education provided by accredited professional organization
What is the beginning nurse’s roles on client care?
- Practices in accordance with legal principles and the code of
ethics in making personal and professional judgment - Utilizes the nursing process in the interdisciplinary care of
clients that empowers the clients and promotes safe quality
care - Maintains complete, accurate and up-to-date recording and
reporting system - Establishes collaborative relationship with colleagues and other
members of the team to enhance nursing and other health care
services - Promotes professional and personal growth and development
What is the beginning nurse’s role on management and leadership?
- Demonstrates management and leadership skills to
provide safe and quality care - Demonstrates accountability for safe nursing practice
- Demonstrates management and leadership skills to
deliver health programs and services effectively to
specific client groups in the community setting - Manages a community/village based health
facility/component of a health program or a nursing
service - Demonstrates ability to lead and supervise nursing
support staff - Utilizes appropriate mechanism for networking, linkage
building and referrals
What is the beginning nurse’s role on research?
- Engages in nursing or health related
research with or under the
supervision of an experienced
researcher - Evaluate research study/ report
utilizing guidelines in the conduct of
written research critique - Applies the research process in
improving patient care in partnership
with a quality improvement/ quality
assurance/ nursing audit team
Statement of philosophical ideals of right and wrong that define the principles the nurse will use to provide care to clients
Code of ethics
What are the professional responsibilities and roles of a nurse?
- Autonomy and accountability
- Caregiver
- Patient advocate
- Educator
- Communicator
- Manager
What are the trends in the nursing profession?
- Importance of nurses’ self-care
- Health care reform and costs
- Demographic changes
- Evidence-based practice
- Quality and safety education for nurses
- Emerging information technologies
- Genomics
- Health policy
What are the 8 professional nursing organization in the Philippines?
- Ang Nars, Inc
- Association of Deans of Philippine Colleges of Nursing (ADPCN)
- Association of Diabetes Nurse Educators of the Philippines, Inc (ADNEP)
- Association of Nursing Service Administrators of the Philippines (ANSAP)
- Association of Private Duty Nurse Practitioners Philippines (APDNP)
- Critical Care Nurses Association of the Philippines, Inc (CCNAPI)
- Gerontology Nurses Association Association of the Philippines (GNAP)
- Military Nurses Association of the Philippines (MNAP)
- Mother and Child Nurses Association of the Philippines (MCNAP)
- National League Philippine Government Nurses (NLPGN)
- Occupational Health Nurses Association of the Philippines (OHNAP)
- Operating Room Nurses Association of the Philippines (ORNAP)
- Philippine Hospital Infection Control Nurses Association (PHICNA)
- Philippine Nurses Association of the Philippines (PNA)
- Philippine Nursing Informatics Association (PNIA)
- Philippine Nursing Research Society (PNRS)
- Philippine Oncology Nurses Association (PONA)
- Philippine Society of Emergency Care Nurses (PSECN)
- Renal nurses Association of the Philippines (RENAP)
- Society of Cardiovascular Nurse Practitioners of the Philippines (SCVNPP)
- The organization of people, institutions, and resources to deliver health care services to meet the health needs of a target population, whether a single-provider practice or a large health care system
- totality of all policies, facilities, equipment, products, human resources and services which address the health needs, problems and concerns of the people
- in the us, it is termed as integrated health care delivery which were developed with a focus on improving health care quality and decreasing overall health care costs
- in the philippines, it is termed service delivery network which were redefined to suit universal health care or kalusang pangkalahatan
Health Care Delivery System
Identify the disease prevention based on its definition:
Health promotion and illness prevention
- based on the notion of maintaining optimum level of wellness
Primary Prevention
Identify the disease prevention based on its definition:
Diagnosis and Treatment
-requiring emergency, intensive and around the clock acute care
Secondary Prevention
Identify the disease prevention based on its definition:
Rehabilitation, Health Restoration and Palliative Care
- helps individuals move to their previous level of health
Tertiary Prevention
Identify the disease prevention based on its activities:
Adequate and proper nutrition, weight control and exercise, stress reduction, smoking cessation campaigns, environmental programs
Primary Prevention
Identify the disease prevention based on its definition:
Early detection and screening, diagnostic and treatment facilities, outpatient surgical units
Secondary Prevention
Identify the disease prevention based on its definition:
End of life care, rehabilitation services
Tertiary prevention
Healthcare system whose goals are to provide cost-effective, quality care that focuses on decreased costs and improve outcomes to group of clients
Managed care
Involves multidisciplinary teams that assume collaborative responsibility for care for groups of clients. Uses critical pathways to track client’s progress
Care management
System which utilizes the best possible use of nursing personnel based on education preparation and skill sets
Differentiated practice
One nurse is assigned to and responsible for the comprehensive care of a group of clients during a shift
Case Method
Focuses on jobs to be completed, based on production and efficiency model
Functional Method
Delivery of nursing care to individual clients by a group of providers led by a professional nurse
Team Nursing
One nurse is responsible for overseeing the total care of a number of hospitalized client 24 hours a day 7 days a week
Primary Nursing
Is a problem-solving approach to clinical practice that combines the deliberate and systematic use of best evidence in combination with a clinician’s expertise, patient preferences and values and available health care resources in making decisions about patient care
Evidence Based Practice (EBP)
What are the steps for evidence-based practice?
- Cultivate a spirit of inquiry within an EBP culture and environment
- Ask a clinical question in PICOT format
- Search for the most relevant and best evidence
- Critically appraise the evidence you gather
- Integrate the best evidence with you clinical expertise and patient preferences and values to make the best clinical decision
- Evaluate the outcomes of practice changes based on evidence
- Communicate the outcomes of EBP decision or changes
What is PICOT format of a research question?
Population, Intervention, Comparison, Outcome, Time frame
PICOT:
What specific patient population is of interest?
Population
PICOT:
What intervention or policy is being studied
Intervention
PICOT:
What is the main alternative?
Comparison
PICOT:
What should be measured?
Outcome
PICOT:
What is the appropriate time period to assess outcomes?
Time frame
Determine the levels of evidence:
Opinion of authorities and/or reports of expert committees
Level VII
Determine the levels of evidence:
Single descriptive or qualitative study
Level VI
Determine the levels of evidence:
Systematic reviews of descriptive and qualitative studies
Level V
Determine the levels of evidence:
Single, nonexperimental study (Case control, correlational, cohort studies)
Level IV
Determine the levels of evidence:
Controlled trial without randomization (Quasiexperimental study)
Level III
Determine the levels of evidence:
A well-designed RCT
Level II
Determine the levels of evidence:
Systematic review or meta-analysis of randomized controlled trials (RCTs) Evidence-based clinical on systematic reviews
Level I
Key communication strategy that produces a written account of pertinent patient data, clinical decisions and interventions and patient responses
Documentation
What are the purposes of the health care record?
- Facilitating interprofessional communication
- Legal record of care provided
- Justification for financial billing and reimbursement of care
- Audit, monitor and evaluate care provided for quality improvement
- Resource for education and research
What are the legal guidelines for documentation?
- Do not document retaliatory or critical comments
about a patient or care provided by another health
care professional. Quote all patient statements - Correct all records promptly.
- Record all facts
- Document discussions with providers that you
initiate. - Document only for yourself
- Avoid using generalized, empty phrases such as
status unchanged, had good day - Begin each entry with date and time and
end with your signature and credentials - Protect security of your password
- Do not erase or scratch out errors while
recording
10.Do not leave blank spaces or lines in a
written progress note
11.Record all written entries legibly using
black ink.
What are the different formats of nursing documentation?
Narrative, PIE, Focus charting, SOAP
Identify the nursing documentation formats:
A document stating what patient said
Narrative
PIE:
Example:
Lack of knowledge related to inexperience with disease condition
P: nursing Problem or diagnosis
PIE:
Example:
- Provided brochure on anticoagulation therapy for DVT. - - Explained rationale for bed rest and daily blood tests to check anticoagulation level
- Explained that heparin infusion will be stopped when PT/INR is at therapeutic level and that he can expect to take warfarin for about 6 months until clot resolves
I: Interventions that will be used to address the problem
PIE:
Example:
Patient states, “I’m worried about the blood clot, but I understand how it is being treated.” Able to teach back and verbalize that the heparin infusion will be stopped when PT/INR tests are “normal.” Also states that he expects to take warfarin for about 6 months until clot in leg dissolves
E: Nursing evaluation
What type of nursing documentation format has DAR?
Focus charting
What is DAR?
Data, Action or nursing intervention, Response of the patient
Focus charting:
Example:
Patient states, “My leg is so swollen. I’m worried about this blood clot. Do you know how they are going to treat it?”
Data
Focus charting:
Example:
Provided brochure on anticoagulation therapy for DVT. Explained rationale for bed rest and daily blood tests to check anticoagulation levels. Explained that heparin infusion will be stopped when PT/INR is at therapeutic level
Action of Nursing intervention
Focus Charting:
Example:
Able to teach back and verbalized that heparin infusion will be stopped when PT/INR reaches “normal level” and that he can expect to take warfarin for 6 months after discharge until clot is fully resolved
Response of the patient
What is SOAP?
Subjective, Objective, Assessment, Plan
Is that all standard for normal assessment finding or for routine care activities are met unless otherwise documented
Charting by Exception
Charting by Exception incorporates standards of care and use clearly, predefined statements for nursing documentation of WDL or WNL which both means what?
Within Define Limits, Within Normal Limits
Determine the hours of care and number of staff required for a given group of patients every shift or every 24 hours.
Is not part of the patient’s health record
Acuity Rating System
In an Acuity Rating system what does 1 and what does 5 mean?
1- independent in all but one or two aspects of care, almost ready for discharge
5- totally dependent in all aspects of care requiring intensive care
Is the use of information systems and other information technology to record, monitor, and deliver patient care, and to perform managerial and organizational functions in health care
Healthcare information technology (HIT)
Computer hardware and software dedicated to the collection, storage, processing, retrieval, and communication of patient care information in a healthcare agency
Health care information system
Is a large, computerized database management system that is used to access patient data needed to plan, implement, and evaluate care
Clinical information system
Contains rules and logic statements that link information required for clinical decisions to generate tailored recommendations for individual patients, the recommendations are presented to health care providers as alerts, warning, or other information for consideration
Clinical decision support systems
Is a universal phenomenon influencing the ways in which people think, feel and behave in relation to one another. Nurses help patients recover in the face of illness, give meaning to their illness and maintain or reestablish connection
Caring
Evaluates patient’s perception of caring
Caring Assessment Tool
Person-to-person encounter conveying a closeness and sense of caring. Eye contact, body language, voice tone, listening and a positive and encouraging attitude act together to create openness and understanding
Providing Presence
Comfort measure that reaches out to patients to communicate concern and support. It may be contact touch, caring touch, protective touch, therapeutic touch
Touch
Silence yourself and listen with an open mind
Listening
Based on Swanson theory of Caring
Knowing the patient
Caring in the nursing practice includes 2 last what?
Spiritual Caring, Relieving symptoms and suffering
Is essential to establish nurse-patient relationships and deliver high-quality patient-centered care
Communication
What are the levels of Communication?
1, Intrapersonal Communication
2. Interpersonal Communication
3. Small group Communication
4. Public Communication
5. Electronic Communication
Important aspects such as vocabulary,
denotative and connotative meanings,
pacing, intonation, clarity and brevity
Verbal communication
Includes personal appearance, posture
and gait, facial expression, eye contact
gestures, sounds and territoriality and
personal space
Nonverbal communication
Identify the zone of personal space:
0-18’’
Parents and children, lovers, spouses/partners
Intimate distance zone
Identify the zone of personal space:
18’‘-4’
Close friends
Personal distance zone
Identify the zone of personal space:
4’-12’
Co-workers, social gathering, friends, work situations
Social distance zone
Identify the zone of personal space:
12’+
Actors, total strangers, important officials
Public distance zone
Identify the special zones of touch by areas of the body and identify the permission needed:
Hands, arms, shoulders, and back
Social Zone: Permission usually not needed
Identify the special zones of touch by areas of the body and identify the permission needed:
Mouth, wrists, feet
Consent Zone: Permission is needed
Identify the special zones of touch by areas of the body and identify the permission needed:
Face, neck, front of the body
Vulnerable Zone: Special Care needed
Identify the special zones of touch by areas of the body and identify the permission needed:
Genitalia and rectum
Intimate zone: Permission and great sensitivity needed
What does AIDET stand for?
Acknowledge, Introduce, Duration, Explain, Thank
Specific responses that encourage expression of feelings and ideas and convey acceptance and respect
Therapeutic Communication techniques
Identify the Therapeutic Communication technique:
Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response
Using silence
Identify the Therapeutic Communication technique:
Using statements or questions that (A) encourage the client to verbalize, (b) choose a topic conversation, and (C) facilitate continued verbalization
Providing general leads
Identify the Therapeutic Communication technique:
Making statements that are specific rather than general and tentative rather than absolute
Being specific and tentative
Identify the Therapeutic Communication technique:
Asking broad questions that lead or invite the client to explore
Using open-minded questions
Identify the Therapeutic Communication technique:
Providing appropriate forms of touch to reinforce caring feelings
Using touch
Identify the Therapeutic Communication technique:
Actively listening for the client’s basic message and then repeating those thought or feelings in similar words
Restating or paraphrasing
Identify the Therapeutic Communication technique:
A method of making the client’s broad overall meaning of the message more understandable
Seeking clarification
Identify the Therapeutic Communication technique:
A method similar to clarifying that verifies the meaning of specific words rather than the overall meaning of a message
Perception checking or seeking consensual validation
Identify the Therapeutic Communication technique:
Suggesting one’s presence, interest, or wish to understand the client without making any demands or attaching conditions that the client must comply with to receive the nurse’s attention
Offering Self
Identify the Therapeutic Communication technique:
Providing, in a simple and direct manner, specific factual information the client may or may not request
Giving information
Identify the Therapeutic Communication technique:
Giving recognition, in a nonjudgemental way, of a change in behavior, an effort the client has made, or a contribution to a communication
Acknowledging
Identify the Therapeutic Communication technique:
Helping the client clarify an event, situation, or happening in relation to time
Clarifying time or sequence
Identify the Therapeutic Communication technique:
Helping the client to differentiate the real from unreal
Presenting reality
Identify the Therapeutic Communication technique:
Helping the client expand on and develop a topic of importance
Focusing
Identify the Therapeutic Communication technique:
Directing ideas, feelings, questions, or content back to clients to enable them to explore their own ideas and feelings about a situation
Reflecting
Identify the Therapeutic Communication technique:
Stating the main points of a discussion to clarify the relevant points discussed
Summarizing and planning
Disruptive behavior that are disrespectful, rude, impolite and promote conflict while increasing stress
Incivility
Disruptive behavior that is repeated, health-harming mistreatment of one or more persons by one or more perpetrators
Bullying
Disruptive behavior that is any act of threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at the worksite
Workplace Violence
What are the leading health indicators according to LHI’s
- household food insecurity
- hunger
- homicides
-suicides
-children with obesity
State of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. Who defined this?
Health -(WHO, 1947)
Actualization of inherent and acquired human potential through goal-directed behavior, competent self-care, and satisfying relationship with others. Who defined this?
Health - (Pender et al, Murdaugh et al)
People who are free from disease are not necessarily healthy. Who defined this?
Health - (Pender, 1996)
Health is influenced by a person’s culture and lifestyle. Who defined this?
(Murdaugh et al)
Addresses the relationship between a person’s belief and behaviors. Who are the components of this?
Health belief model - (Rosenstoch; Becker and Maiman)
Health belief model is composed of what 3 components?
- Individual’s perception of susceptibility to an illness
- Individual’s perception of the seriousness of the illness
- Likelihood of taking preventive action
Describes the multidimensional nature of people as they interact within their environment to pursue health. And who is the component?
Health Promotion model - (Murdaugh)
What are the 3 focus areas of health promotion model?
- Individual characteristics and experiences
- Behavior - specific cognitions and affect
- Behavioral outcome
Certain human needs are necessary for human survival and health. Who is the component?
Maslow’s hierarchy of needs
Highest expression of one’s individual potential
Self-actualization
Identify the hierarchy of needs:
Breathing, food, water, shelter, clothing, sleep
Physiological needs
Identify the hierarchy of needs:
health, employment, property, family and social ability
Safety and security
Identify the hierarchy of needs:
Friendship, family, intimacy, sense of connection
Love and belonging
Identify the hierarchy of needs:
Confidence, achievement, respect of others, the need to be a unique individual
Self–esteem
Identify the hierarchy of needs:
morality, creativity, spontaneity, acceptance, experience purpose, meaning and inner potential
Self-actualization
Promotes a patient’s optimal level of health by considering the dynamic interactions among emotional, spiritual, social, cultural and physical aspects of an individual’s wellness
Holistic health model
What are the different holistic interventions?
- Meditation
- Music therapy
- Reminiscence
- Relaxation therapy
- Therapeutic touch
- Guide imagery
What are the components of holistic care?
- Physical
- Spiritual
- Social
- Psychological
What are the internal variables affecting health and health beliefs and practices?
- Developmental stage
- Perception of functioning
- Intellectual background
- Emotional Factors
- Spiritual factors
Considering a patient’s growth and developmental stage helps you predict a patient’s response to an actual illness or the threat of a future illness
Developmental Stage
Perceptions of physical functioning affect people’s health beliefs and practices
Perception of functioning
A person’s belief about health are shaped in part by educational background, traditions, and past experiences
Intellectual background
A patient’s degree of stress, depression, or fear influences health beliefs and practices
Emotional factors
Is reflected in how people live their lives and serves as an integrating theme in people’s lives and often provides motivation to participate in health promoting activities
Spiritual factors
What are the external variables affecting health and health beliefs and practices?
- Family role and practices
- Social determinants of health
- Culture
The roles and organization of a family influence how each family member defines health and illness and values health practices
Family role and practices
Health is determined by a person’s circumstances and environment, Social, commercial, cultural, economic, environmental and political
Social determinants of Health
It influences the approach to the health care systems, personal health practices, and the nurse-patient relationship
Culture
Public health focuses on what?
- Health promotion
- Health education
- Illness prevention
Helps individuals maintain or enhance their present health
Health Promotion
It includes proving information on topics such as physical awareness, stress management, and self responsibility to enable individuals to improve their health
Health education
Activities such as immunization programs and blood pressure screenings
Illness prevention
True prevention. It’s goal is to reduce the incidence of disease.
EX:
Health education program
Nutritional programs
Primary Prevention
Focuses on preventing the spread of disease, illness, or infection once it occurs.
ex:
Mass screening
Focused exams to cure and prevent disease
Secondary Prevention
It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration. Activities are directed at rehabilitation rather than diagnosis and treatment
Tertiary Prevention
What are nonmodifiable risk factors?
- Age
- Gender
- Genetics
- Family history
What are modifiable risk factors?
- Lifestyle practices and behaviors
- Environment
State in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired
Illness
Usually reversible and has a short duration. Symptoms appear abruptly, intense and subside after a relatively short period
Acute Illness
Lasts more than 6 months: irreversible and affects functioning in one or more systems
Chronic Illness
People often adopt
cognitive, affective, and
behavioral reactions to their
diseases that are influenced
by sociocultural &
psychological factors.
Illness Behavior
What are the variables influencing illness and illness behavior
- Physical stressors
- Work stress
- Exposure to air pollution
- unsafe environment
- heredity and individual practices
- influence of emotional, intellectual, social, developmental, and spiritual factors
Patient’s perception of symptoms and the nature of a disease
Internal variables influencing illness and illness behavior
Variables influencing a patient’s
illness behavior include the
visibility of symptoms, social
groups, cultural background,
economic variables, accessibility
of the health care system &
social support
External variables influencing illness and illness behavior
Impact of Illness
- Behavioral and emotional changes
- Impact on body image
- Impact on self-concept
- Impact on family roles
What is critical thinking and clinical reasoning
Clinical judgement
Process of international higher level of thinking to define a client’s problem, examine evidence-based practice in caring for the patient and making choices in the delivery of care
Critical Thinking
Cognitive process that uses thinking strategies to gather and analyze client information, evaluate its relevance and decide on nursing actions to improve outcomes
Clinical Reasoning
Conclusion about a patient’s needs or health problems that leads to taking or avoiding action, using modifying standard approaches or creating new ones based on patient’s response
Clinical Judgement
The process of critical thinking requires the nurse to what?
- Think ahead - begin proactive
- Apply thinking while acting
- Think Back - reflective thinking
Identify the technique of critical thinking:
Application of a set of questions to a particular situation or idea to determine essential information and ideas and discard unimportant ones
Critical Analysis
Identify the technique of critical thinking:
Technique one can use to look beneath the surface,
recognize and examine assumptions, search for
inconsistencies, examine multiple points of view
and differentiate what one knows from what one
believes
Socratic Questioning
Identify the technique of critical thinking:
Generalizations formed from a set of facts or
observations (from specific to general)
Inductive Reasoning
Identify the technique of critical thinking:
Reasoning from general premise to specific
conclusions
Deductive Reasoning
Identify the level of critical thinking:
consider wide array
of clinical alternatives, apply all
elements of clinical judgment
model automatically
Commitment
Identify the level of critical thinking:
independent decision-making,
creativity, with initiative to look beyond
expert opinion, consideration of different
solutions, options and approaches
Complex
Identify the level of critical thinking:
answers are either right or wrong, single
solution to a problem
Basic
Technique that uses a graphic depiction of nonlinear and linear relationships to represent critical thinking. Allows the nurse to map words on a page and focus on concepts and relationships
Concept Mapping
A systematic, rational method of planning and proving individualized nursing care. Purposes to identify a client’s health status and actual or potential healthcare problems or needs, establish plans, and to deliver specific nursing interventions
Nursing Process
