Midterm Review Flashcards
The 5 W’s of Conscious Inquiry
What are you relating to Who are you relating to Why are you relating When are you relating Where are you relating
Categories of Strength Based Care (MKRA)
Strength of mindset
Strength of knowledge and knowing
Strength of relationship
Strength of advocacy
5 C’s of Relational Capacities
Compassionate Curious Committed Competent Corresponding
Marie Rollet Herbert
Wife of physician from France, found starvation, sickness, and threats of attack, sought advice on remedies and cures in treating the ill, educated indigenous children
Jeanne Mance
Founded the first hospital in Canada (hotel dieu in Montreal)
Marquerite d’Youville
Moved nursing care out of the Christian sanctuary and into the community
Founder of the grey nuns (first group of visiting nurses in Canada)
Fought for rights of the poor
Provided nursing care for all without consideration of race or class
Florence Nightingale
Founder of modern day nursing
Lady of the lamp
Wealthy upper class upbringing
Educated as a nurse in Germany worked in England and France with nuns
Worked in a London street hospital
British Crimean war camp across the Black Sea in 1853
Saw unsanitary conditions and decreased death count by 2/3 by improving sanitation, hygiene, and nutrition
Saved thousands of lives by promoting comfort, cleanliness, ventilation, sanitary conditions (while collecting data)
Made nursing a viable profession with education
Started the first nursing school in London in 1860
Florence nightingales characteristics of a good nurse
Sobriety Altruism Loyalty Self sacrifice Deeply rooted in Christianity
Nursing education in Canada
1890’s
Decrease in number of doctors/nurses/hospitals thus lady Aberdeen formed VON so visiting nurses could reach underserved areas
1919
First university nursing program at UBC (all training still provided by hospital) all stemmed from the WWI pandemic and post war health conditions
1924
CNA requirements for nurses to be registered. Nursing became a regulated profession, improved education and standards. RN
1959
First masters in nursing program at western u
1960’s
Expansion of university programs in Canada; UofT integrated program into university vs hospital based
1991
First doctoral program at U of Alberta. There are now 17 PhD nursing programs in Canada
Kathryn Hopkins Kavanagh
Emphasized that the history of nursing has evolved in relation to the social and cultural ethos of varied times and circumstances. Perhaps more than any other occupation, nursing has been shaped by social conceptions of women and their place in society.
Societal Forces and Nursing
Women’s rights
Objectified view
Male stereotypes
Public image
Social determinants of health
There is more to health than the absence of disease
Highlights health promoting actions
Self concept
Sum of ones beliefs about oneself with develops overtime and is influenced by interactions with surroundings
Temporal aspect - it is dynamic and constantly developing
Spatial aspect - influenced by context/location/surroundings
Microsystem
Family
School
Peers
Neighborhood
Mesosystem
Interaction of systems
Exosystem
Religion Media Education Medicine Community
Macrosystem
Culture
Politics
Economy
Social conditions
Chronosystem
Historical time
Changes: personal, social
Encouragement
Develops confidence
Feeling of control over ones life
How we see ourself in relation to others
Belonging, competence, positive self concept, self worth
Discouragement
Repeated failures -frustration -anger -fear -depression Feeling of helplessness Loss of motivation and confidence Low self concept
Illness and self concept
Anxiety, depression, stress, trauma reactions, changes in body image, changes in role performance
Beliefs
Convictions that we generally hold to be true usually without proof or evidence
Values
Strong personal beliefs about the worth of a given idea, attitude, custom, or object
Influence behaviour
Right vs wrong
Evolve as we age
Morals
Internal personal understanding of how we believe we ought to act Personal opinions on right vs wrong Action oriented Moral integrity -steadfastness -moral autonomy -fidelity -moral seamlessness
Moral distress
We know the right thing to do but the system structures or personal limitations make it impossible
Ethics
External societal organization of right and wrong (this can vary for people, professions and organizations)
How we should behave
CNA code of ethics
Ethical dilemma
When there are two or more equally compelling reasons for and against a course of action.
Choosing one course of action means letting the other one go.
Types of ethics
Nursing ethics - protect the public and inform nursing practice (CNA CNO)
Bioethics - healthcare and research
Feminist ethics - gender inequities and power
Ethical theories
Consequentialism
Deontological
Principlism
Consequentialism
Utilitarian theories - outcome based, greatest good for the greatest number, end justifies the means
Deontological
Duty
Right or wrong is determined by the nature of the act itself (less regard foe the results, actions are guided by morals)
Principlism
Respect for autonomy
Beneficence
Non maleficence
Justice
Health Care Consent Act (HCCA)
Sets our explicit rules on when consent is required for treatment or admission to a care facility and who can give the consent when the client is incapable of doing so
Informed consent information must include
What - nature of the treatment
Why - expected benefits of the treatment
What if’s/then what - risks and side effects
What else - alternative course of action, consequences of not having treatment
Working through ethical scenarios
Assessment
Plan
Implement
Evaluate
Self regulation
Some professions are granted the right to regulate their own members (rather than the government) we call this a self regulated profession
This is granted when a profession shows they can put the interests of the public ahead of their own professional interests
When self regulated each profession has a regulatory body (CNO)
CNO determines eligibility to practice, scope of practice, standards of practice and follows up on issues and concerns
CNO
Regulatory body
Protects public
Controls activities
Renews RN license
CNA
national and global voice for the nursing profession in Canada
Code of ethics
RNAO
Professional association Assists in political action at the provincial level Best practice guidelines Learning/career advancement Legal assistance program
CNO - 7 components necessary for nursing practice
Cognitive Communication Interpersonal Behavioural Psychomotor Sensory Environment
The nursing act
Establishes the mandate of the CNO and defines scope of practice Regulates: - registration - scope of practice - controlled acts - quality assurance - professional misconduct
Entry to practice requirements
Successfully meet nursing education requirements
Provide evidence of nursing practice
Successfully complete national registration (NCLEX)
Successfully complete jurisprudence exam
Proficient in English or French
Provide proof of citizenship, permanent residency
CNO professional standards
Accountability Continuing competence Ethics Knowledge Knowledge application Leadership Relationships
Stages of the Nursing Process
assessment nursing diagnosis planning implementation evaluation
4 types of assessment
- initial - first meeting the patient, assessment of presenting problems
- focused - details about presenting concern to validate data/info
- time lapsed - ongoing; re evaluate patient status, better? worse? same?
- emergency - airway, breathing, circulation
assessment
ongoing process involving critical thinking and data collection (objective and subjective)
source of data
client, family and significant other, health care team, medical records
ways to collect data
- interview
- physical assessment
- form completion (intake form)
- chart review
- diagnostic and lab results
nursing diagnosis
employ clinical judgements to formulate nursing diagnosis
Purpose: to prioritize, plan, and implement patient care
Involves: analyzing data, identifying health problems/risks/strengths and formation of a diagnostic statement
components of the nursing diagnosis
1) the problem: includes the focus of the diagnosis (eg. gas exchange) and the qualifier (eg. impaired)
2) ethology (cause/risk) (“as related to”)
3) defining characteristics (subjective/objective data supporting diagnosis) (“as evidenced by”)
actual nursing diagnosis
_____ related to _____ as evidenced by _____
risk for nursing diagnosis
risk for _____ as evidenced by ______
wellness nursing diagnosis
readiness for ______ as evidenced by ______
types of nursing diagnosis
- actual problem focused nursing diagnosis
- risk nursing diagnosis
- syndrome diagnosis
- health promotion/wellness nursing diagnosis
- possible nursing diagnosis
planning
prioritizing problems and diagnosis
formulation of goals and outcomes - care plans
3 types of planning
- initial - immediate (upon admission)
- ongoing - continuous (expect to change based on reassessment)
- discharge - help with discharge planning, from your care, from hospital, etc.
classification of priorities
high - threat to life, risk of harm/danger
intermediate - less urgent (knowledge deficit)
low - future, long term
types of goals
- client goal - reflects clients highest possible wellness level and independence of function
- immediate (short term) goal - outcome expected within hours to a week
- intermediate goal - expected within weeks
- long term goal - expected in days, weeks, or months
(note: goals must be SMART)
care plans
outline the care provided and are holistic, they include:
- nursing diagnosis
- nursing interventions
- patient focused outcome
implementation
- provision of nursing care (intervention is carried out)
- constant evaluation of how intervention is being tolerated and its effectiveness
- multiple interventions for one goal
types of interventions
nurse initiated
physician initiated
collaborative
selection of interventions
1) characteristics of nursing diagnosis
2) goals and expected outcomes
3) evidence base for interventions
4) feasibility of the intervention
5) acceptability to the client
6) nurse competency
evaluation
evaluation of the interventions
assess the client and compare before and after
evaluation process
1) identify and evaluate criteria and standards
2) collect evaluative data
3) interpret and summarize findings
4) document findings and clinical judgements
5) terminate, continue, or revise the care plan
