Module 1 Flashcards
1
Q
How are practice, theory, and research related?
A
A nurse DEVELOPS and IDEA, then conducts RESEARCH, and if supported, formulates a THEORY
2
Q
What is the significance of the framingham studies?
A
Launched multidisciplinary research conducted over 50 years in Birmingham, Massachusetts. The research conducted ended up changing the treatment for diabetes breast, cancer, heart disease, arthritis, and others. For example, mammography was once believed to be unreliable until after the research, where it was the number one thing they used.
3
Q
Benner’s Novice to Expert Theory
A
proposed by Patricia Benner. She studied the progression of being a nurse beginner to an expert. Helped set performance expectations.
Benner = Better. Nursing getting ‘better’ at her job
4
Q
Watson’s science of human caring significance
A
Developed by Gene Watson. Researched how caring about the patient impacts care. Before Watson research, nurses were mechanistic meaning they prioritize doing tasks over showing care. After the research it was the opposite.
‘watson’ = want sum care
5
Q
did Lawrence Nightingale display mechanistic or caring nursing?
A
she emphasize mechanistic nursing despite compassion.
6
Q
What does being an expert mean?
A
Have intuitive grasp, broader situation and able to analyze and think critically for creative solutions
7
Q
What is being proficient mean?
A
Decision making and prioritizing come more easily. Practices with holistic protective rather than in steps or parts.
8
Q
What does being competent mean?
A
intentional short term and longer-term planning for Care. Efficient and organized.
9
Q
What is an advanced beginner?
A
Provides care drawing from some practical experience. Can perform task but has difficulty improvising and prioritizing.
10
Q
What is being a novice mean?
A
beginners with no experience. Rigid adherence to rules. Minimal judgment.
11
Q
What is the general understanding of a theory?
A
an organized set of ideas designed to help find meaning in our experiences with patients. It allows us to organize our thinking around a certain idea. Or it allows us to develop new ideas as well.
12
Q
What are the characteristics of theories?
A
- they are derived from observations. The observation themselves can be a fact, but theory is not fact.
- subject to revision. Not static.
- offer way to link concepts and see reality in a structured way
13
Q
What are the components of a theory?
A
they include assumptions, phenomena, concepts, definitions, and statements.
14
Q
What are assumptions
A
ideas presumed to be true without any testing or proof. They are taken for granted.
For example, nursing theories implicitly assume that people are complex, even though they do not state it explicitly.
15
Q
what are phenomena?
A
observable and experiential aspects of reality. They are the subject matter or domain often referred to phenomena of concern.
for example, pharmacists focus on medication. Nurses focus on the human beings.
Watson theory of caring allows us to describe nursing phenomena.
16
Q
What is a concept?
A
A mental image or representation of phenomena option based on observations. It helps to organize and categorize the idea.
for example, if you have a fever, you may have the subjective experience a feeling warm. Theoretically, do you know that elevated body temperature and physiology of temperature regulation exist. You may think of a thermometer symbol or visual imagery of someone with fever. This is the concept.
Concepts can range from very simple to abstract. It may range from being concrete to being very complex.
‘con man’ concept. a con man does a puppet show. puppets are representatives
17
Q
what is a simple and concrete concept example?
A
it means being directly observable. for example, height and weight.
18
Q
what is a complex and abstract concept?
A
inferred through the indirect observations or direct observations. Like self-esteem. Or overall wellness.
19
Q
What are the 10 items called in Watson’s Theory of caring?
A
Concepts.
20
Q
what is Watson’s 10 caring processes?
A
forming an altruistic value system, instill hope in others, be sensitive, form trusting relationships, accept either positive/negative feelings, use scientific problem-solving, promote teaching/learning, create a nurturing environment. In many ways fulfill their needs, and understand their experience as a human being.
21
Q
what is the definition? in components of a theory. what types of definitions are there
A
statement that specifies the meaning of a term or concept
- Theoretical definition is conceptual. For example, pain is an unpleasant sensory and emotional experience.
- operational definition serves to explain measurement of a concept. For example, Pain is defined as the patient verbal statement of being in pain.
22
Q
Statements or propositions are what in theory?
A
The link among concepts. For example, in Maslow’s hierarchy of needs, concepts such as physiological needs and self-esteem are linked by the statement:
physiological needs must be met to an acceptable degree before a person can attempt to meet self-esteem needs.
Think of “S” in statement: a chain link is two S’s crossed on each other.
23
Q
summarize the five aspects of theory. With their definitions.
A
assumptions are presumed truths without testing.
Phenomena are observable realities defining a discipline’s focus.
Concepts are mental representations, organizing phenomena.
Definitions are clarifications of concept meanings.
Statements are propositions linking concepts.
24
Q
What is a paradigm?
A
The worldview or ideology of a discipline. Represents the broadest most global conceptual framework. It is not a theory, but a perspective or lens through which phenomenon are understood.
For example, A medical paradigm might focus on just treating the disease and emphasize cells organ and body parts. A nursing paradigm might view the person holistically, focusing on responses to changes and health.
Paradigms are not theories. They simply represent how we see things.
paramore wearing glasses
25
what is conceptual framework?
It’s a set of related concepts forming a pattern. The pattern is called the theoretical framework.
Conceptual framework is generally more broad than a theory. It’s typically not developed using research and not tested in practice. As often just used organize ideas and guide research.
sometimes it could be challenging, trying to differentiate between a theory and a conceptual framework. Sometimes early nursing theories are classified as a conceptual framework while later theories are classified as theories.
26
What is a model?
A symbolic representation of a framework or concept. It can take many forms.
A diagram, graph, picture, drawing, physical model. It can be very simple or very complex.
27
What is a conceptual model?
A model expressed with words. The words serve as symbols. Sometimes conceptual model is used interchangeably with a conceptual framework.
28
how do theories, models, paradigms, and frameworks relate to each other?
They differ depending on the level of detail and testing done.
- A theory has the highest level of research, detail, and organization. Like Watson’s theory of caring.
- A conceptual model organizes ideas with words. For example, full spectrum model. Interchangeable with conceptual framework.
-conceptual framework links to concepts together to form a pattern. Broad level of detail. Not always tested. For example, early nursing theories.
- a model is a symbolic representation that is visual or physical. It can be detailed or simple. For example, diagrams.
- a paradigm is a very broad perspective. It’s abstract with no testing done. An example is nursing versus medical paradigm.
29
How are theories developed?
- First an idea is formed that they want to explore. Second, they use either inductive or deductive reasoning.
- Neither inductive or deductive approach guarantees fact.
30
What is inductive reasoning?
move from specific observations to general conclusions.
for example, a patient’s temperature is 101 and their pulses 104 and the respiration rate is 20 breast for a minute. Your conclusion is at the patient is ill.
IN- duction is bringing specific data INto the equation to form a general conclusion.
31
what is deductive reasoning?
moves from a general premise to a specific conclusion.
- based on knowing that pylenephritis causes fever and back pain, you deduce a patient with pylenephritis will likely exhibit the symptoms.
32
Every nursing theory should address what 4 foundational concepts?
1. Person: an individuals health reactions. Learning needs, fears, family concerns, and discharge arrangements. The absence of this concept leads to a mechanistic view of care.
2. Environment: the physical surroundings, social context, and any external factors. For example, keep a patient environment, clean, colorful, quiet
3. Health: the individual state of well-being or illness. Nursing theories aim to improve or maintain health through interventions.
4. Nursing: the role of the nurse and the actions of a nurse.
## Footnote
PEN H
33
what does a meaningful nursing theory do?
it defines the four concepts and explains interrelationships, providing a framework for holistic and patient centered care.
34
how does Watson theory work inside of the four concepts for all nursing theories?
- person focuses on the individual and caring relationship between the nurse and the patient.
- environment creates a healing environment, like clean, quiet, colorful surroundings.
- health focuses on all caring behaviors to improve the health and well-being of the person
- nursing focuses on the caring moments between the nurse and the person
35
what is the puzzle of nursing theory?
Four concepts form a ‘puzzle’ of nursing theory, with proper integration reflect full spectrum nursing care
## Footnote
H PEN. health patient environment nursing
36
What’s the definition of of a clinical practice theory?
they do not attempt to explain all aspects of nursing, they simply guide nursing actions involved with specific areas and decision-making.
37
What are some examples of clinical practice theories?
nightingale’s environmental theory, Dr. Imogene Rigdon’s theory on bereavement, Nola Penders health promotion model, Dr. Katherine Kolcaba’s theory of holistic comfort.
38
Explain nightingale’s environmental theory
Emphasized the **environment** in patient care. Influenced designs of hospitals and construction for decades.
39
Explain Dr. Imogene Rigdon’s Theory on Bereavement
- studied grief in older women and how their grief compares to men in young women.
- it is now used in hospice care to support older women experiencing loss.
## Footnote
Imogene Rigdon = Imagine rigid dead bodies
40
Explain Nola Pender’s Health Promotion Model
Focused on preventative care and health promotion. Now it serves as the basis for most health promotion delivered by nurses.
## Footnote
pender=pander to someone's ideas. pander means to cater or promote to someone
41
Explain Dr. Katharine Kolcaba’s Theory of Holistic Comfort
holistic perspective on discomfort. It’s surpassed earlier theories of pain and anxiety. is now used to help nurses focus on the bigger picture in supporting their patients physically emotionally and environmentally.
## Footnote
Kolcaba= cold cab is discomforting
42
What are grand, middle range, and practice theories?
- Grand theories are broad. Address large areas of concern. For example, Watson theory of caring. However, it is limited because **it does not specify nursing interventions.**
- Middle range theories are narrow scope and more specific than grand theories. It is used to develop nursing protocols and procedures.
- a practice theory is focused on situational, specific situations with clerical goals, and **interventions.** For example, a practice theory, addressing end of lifecare might specify how nurses should communicate with grieving families.
43
how does theories in nursing research serve a purpose? Whats an example
they provide a structured framework for research questions, what to measure (variables), and how to interpret the results.
-Kolcaba’s Holistic Comfort Theory: tested the hypothesis that comfort interventions improve the health of the whole person. This gives research a direction to go in.
44
Who was Florence Nightingale?
A nurse theorist. Transformed nursing during the Crimean war. The founder of modern nursing.
- She believed soldiers would have better survival rates if they have a clean, healthy environment and nutritious food. It supported the germ theory.
-she conducted meticulous research by recording hospital conditions before+ after implementing the changes. She then found statistical evidence that a clean environment improves patient health. This greatly impacted soldier mortality rates. It revolutionized the British army Hospital system.
45
Who was Virginia Henderson?
- A US Army nurse in 1918. Questioned mechanistic nursing and a subordinate role of nurses.
- developed a 14 basic needs (of patients) framework for nursing care so that nurses could understand what it means to be a nurse.
-Redefined nursing with her definition in 1966.
-Address both of physical AND emotional aspects of patient care.
## Footnote
Virginia= Verging on.both emotional and physical
46
Who was Hildegard Peplau?
- psychiatric nurse. proposed that health could be improved for psychiatric patients if there was a better way to communicate with them. this was a problem back in the early 1900s before there was a personal relationship with psychiatric patients and psychotropic drugs. Patients were often agitated and extremely difficult to communicate with.
- she did research that showed developing a relationship makes treatment more effective.
- Advocated for advanced nursing education.
- Played a critical role and establishing nursing as a regulated, standardized, and professional discipline.
- advocated for expansion of advanced nursing rules.
## Footnote
Peplau= pep 'talk', talking to psychiatric patients more effectively
47
Who is Patricia Benner?
- Focused on what makes an expert nurse. For example, an ICU nurse that intuitively knows when to intubate.
- interviewed ICU nurses to determine the five stages of nursing knowledge and skill development (novice, advanced beginner, competent, proficient, expert *in NUR211 module 1 flashcards*)
- Formed the **primary caring model**.
48
what is the primary caring model?
-Caring helps clients cope with stress and offers nurses an interpersonal relationship with the patient. it sees every person as unique. Since every person is unique, caring should be tailored to every person.
49
how does Patricia Benner primary caring model fit into the four components of nursing theory?
- Person: focuses on nurse skill level and the patient needs
- nurse: matches skill level to the patient acuity
- health: nurse contributes to health based on their skill level
- environment: the ICU serves as the defined setting
50
Who is Madeleine Leininger?
- founder of transcultural nursing. Emphasized caring through **cultural competence**.
- developed theory while working with diverse children in a psychiatric hospital. Explored if treatment was more effective when framed around their cultural context.
## Footnote
Madeleine = 'Mad land', meaning a world with many cultures is potentially chaotic without understanding and respect.
51
How does transcultural nursing fit into the four components of nursing theory?
- person: an individual with unique, cultural beliefs.
- nurse: the professional who values cultural diversity and accommodates, cultural beliefs.
- environment: the nurse and person interact within the healthcare system.
- health: Health is defined by the individual and may vary by the individuals culture.
52
what is an example of accommodating someone who has cultural beliefs?
A monk who refuses pain medication believing his pain was a spiritual offering to God.
administer medication every eight hours instead of every 3 to 4 hours and provide extra support during the medication‘s active period.
53
Who is Faye Abdullah?
theory of nursing 21 problems. Deliver care to the whole person. problem-solving.
## Footnote
ab-dull-ah'; longest problem list out of all theorys, and the list is incredibly dull
54
Who is Dorothy Orem?
The self-care deficit nursing theory explains what cares required when people can’t care for themselves.
## Footnote
'door' thee opens the 'door' for patients who cannot help themselves
think the O in orem is like an open mouth waiting to be fed
55
Who is Carl Rogers?
person centered model theorist of psychotherapy that recognizes each client as a unique individual.
## Footnote
link to mr. rogers kid show, where fred rogers spoke directly to children, affirming their unique qualities
56
Who came up with theory of attainment?
Imogene King. mutual goalsetting. These interactions can promote growth.
## Footnote
think of a 'king' who is 'kind', builds alliances for 'mutual'
57
Who came up with interpersonal process of nursing?
Jean Watson. caring promotes health and growth. The person as they are and what they will become.
## Footnote
'gene' which connects to the DNA/ foundation of a person. 'watson like watts on', symbolizing energy, growth, and potential being activated.
58
Who is Betty Neuman?
general system theory. A person is an open system with sub systems. The sub systems are physiological, psychological, sociocultural, spiritual, and developmental subsystems. Internal and external environment influences the system.
## Footnote
people are systems. my friends little brother started saying 'bet' when it became cool. an isolated system until it comes into contact with the sociocultural influence. now he is a cool new man 'neuman'
59
theory of health and interacting with the environment- who came up with that?
Margaret Newman. Nurses help patient recognize their own pattern of interacting with the environment and enable patients to use the power from within/expanding consciousness. Opposed mechanistic thinking.
## Footnote
'margaret' = 'magnet' symbolizing attraction and spiritual energy aka expanding consciousness
60
Who is Emestine Wiedenbach?
The purpose of nursing is to meet patients needs for help.
## Footnote
'emestine' = earnest in wanting to help
61
What is the behavioral system model and who came up with it?
Dorothy Johnson. Incorporates five principles of the BEHAVIORAL system. The principles can reach a balance. Nurse helps them reach it.
| attach, depend, ingestive, eliminative, sexual, aggressive, achievement
## Footnote
'johnson' = join son, symbolizeses interconnectedness of subsystems
62
Who is Myra Levine?
came up with a conservation model, which was designed to promote adaptation of the person while maintaining holiness or health.
Conservation of energy refers to balancing energy input and output to avoid excessive fatigue. It includes adequate rest, nutrition, and exercise.
## Footnote
'levine' = 'Le-vine" symbolizes vitality like a vine that conserves energy to growth and survive.
63
Who is Ida Jean Orlando?
Nurses are in tune with a verbal and nonverbal expressions to meet patients needs. And improve patient outcomes.
## Footnote
disney is located in orlando florida. its where I learned a song or 'tune'.
Jean is 'tuned' into verbal and nonverbal cues, much like tuning into a frequency.
64
Who is Rosemary Rizzo Parrse?
invented theory of human becoming, which focuses on the quality of life and reaching the patients potential.
## Footnote
' rosemary rizzo' ='rose-mary rise' like the process of growth
65
Who is Nola Pender?
The health belief model focuses on promoting optimum health through disease prevention, Identify risk, and remove obstacles for patients to comply.
## Footnote
nola pender acts as the preventer, saying no to risks and removing obstacles
66
Who is Martha Rogers?
theory of science of unitary human beings. Focuses on the betterment of humankind through innovation. Keep environment clear of negative energy.
humans are indivisible, dynamic energy fields completely integrated with their environment, meaning they cannot be understood by examining separate parts, but rather as a whole, evolving system in constant interaction with their surroundings; essentially viewing people as "unitary beings
## Footnote
martha stewart on tv as a kid made her seem bigger than just a person; she became my envirinment on tv
67
Who is sir Calista Roy?
Formed adaptation model. inspired by strength and resilience of children. It examines the choices people make as they adapt to illness.
## Footnote
Sir Calista Roy can be imagined as a child's toy knight fighting a dragon
68
which theories are based on needs; theories helps individuals fulfill their physical and psychosocial needs?
nursing problems, basic needs, self-care, deficit, nursing theory
69
My theories are caring, humanistic theories? centered on the person in capacity for achieving growth and health.
Nursing practices, caring, art, transcultural, nursing, person centered model, nursing as a interpersonal process.
70
what theories are based on interaction and interpersonal theories?
theory of goal attainment, general system theory, interacting with the environment, interpersonal communication, needs for help.
71
What theories are based on the outcome? Nurse as a change agent for promoting health and coping with the illness.
Behavioral system model, conservation model, verbal and nonverbal expressions, theory of human becoming, health belief model, science on unitary human beings, adaptation model.
72
Maslows Hierarchy overview
lower level needs must be sufficiently met before higher level needs can be pursued. The dominant need is the most urgent unmet need which takes priority and varies among individuals.
73
what are Maslow’s physiological needs?
Level one. Basic requirements for maintaining life like food, air, water, temperature, elimination, rest, sex, and physical activity. Many aspects of nursing applied to this level.
74
what are Maslow’s safety and security needs level?
Level two. Includes both physical and emotional safety.
Physical safety includes protection from harm, such as falls, infections, or unsafe environments. Adequate shelter with sanitation temperature control.
Emotional safety includes freedom from fear and anxiety. For example, feeling secure in a relationship and the environment.
75
What is Maslows love and belonging needs level?
level three. The need to give and receive love and feel sense of belonging in a group. friendship, intimacy, trust and acceptance. Without it, someone feels isolated, lonely, or critical and demanding. Nurses must help patients establish meaningful relationships and connections during care.
76
What is Maslow’s self-esteem needs level?
level four. The need for accomplishment, confidence, and recognition for others to put it into context, a patient’s change in body image may affect their self-esteem. Another example, if someone can’t do their job because of an illness, they may feel a loss of confidence.
77
what is Maslow’s self actualization level?
They need to reach ones for potential and act unselfishly. Level five.
it’s characterized by someone, exhibiting wisdom, creativity, and responding appropriately. In order for someone to grow, they have to have the desire to know, understand and explore. they must have an appreciation for symmetry order and beauty. This is what someone needs in order to grow.
78
What is Maslow’s transcendence of self level?
level six, added later on. it is the drive to connect with something beyond oneself and to help others realize their potential too. Spiritual, and self sacrificial.
79
What is validation theory?
develop developed by feel and Klerk-Rubin from social work. Provides a new method for interacting with dementia geriatric patients. The approaches to join the person in their current reality instead of trying to correct them.
## Footnote
'rubin' = 'ribbon'. santa, presents & ribbons. santa is imaginary. parents join kids in an imaginary world on christmas day.
80
what is stress and adaptation theory?
developed by hans Selye. Stress can be either be beneficial or harmful. however, when the stress levels exceed the bodies capacity to adapt, it leads to physiological symptoms and eventual illness.
81
what are the three developmental theories that focus on stages of progression for individuals, groups, families, and communities overtime?
1. Erikson’s psychosocial developmental theory that explains psychosocial stages across the lifespan.
2. Theories of family development that outline family changes and dynamics overtime.
3. Kohlberg’s and Gilligan’s moral developmental theories that address, moral and ethical growth in individuals.
- the idea is to identify developmental norms and milestones to tailor nursing actions to the patient stage of development.
82
What is system theory?
- it was originated by Ludwig von Bertalanffy in the 1940s.
- developed system theory that contains subsystems and its interactions.
-**Sub systems** are components of a system that interact like the cardiovascular and renal systems in the body.
-**Interactions** are when sub systems constantly exchange information with one another and the environment.
- Open and closed systems. Systems have input, thorough, output, and feedback.
## Footnote
'ludwig' = 'hedwig' the owl from harry potter. owls were part of a mailing system
83
What is input, thorough, output, feedback inside of a system?
- input: energy, information or materials entering the system.
- Throughput: converting input into output, like planning or thinking.
- Output: result
- Feedback: information used to monitor
84
What is an open system?
Exchange his information and energy freely with the environment.
For example, people, hospitals, body systems. They all display growth development and adaption.
85
What is it closed system?
fixed automatic relationships with little external interaction.
For example, rocks, isolated families, resisting external influences.
86
what are three examples of nursing theories that are based on system theory?
Johnson’s behavioral system model. Kings interacting systems framework. Neuman systems model.
- **Key to system theory = the premises of systems theory is that all complex phenomenon, regardless of their type, have some principles, laws, and organization in common**
87
How can you apply Watson caring theory to holistic nursing care?
Go beyond just administering meds, treating wounds. consider their fears, cultural beliefs, and the involvement of loved ones. Validate their emotional concerns while providing physical care.
88
How can you apply Watson caring theory to honoring personhood?
respect each individuals uniqueness by using patient’s names instead of referring to them by room number. Truly connect with them.
89
How can you apply Watson’s caring theory to transpersonal caring moments?
commit to being genuine and present during your interactions rather than task, oriented behaviors.
90
How can you apply Watson’s caring theory to personal presence?
To be emotionally and physically present with the patient and fully tuned to their needs, avoid distractions and focus on the patient.
91
how can you apply Watson’s caring theory to comfort?
Go be on pain relief to include comfort in four different ways.
1. Physical: manage pain.
2. Psychospiritual spiritual: address emotional and spiritual needs.
3. Social: create a trust between nurse and patient.
4. environmental: I just stimulate, room, temperature, or respect modesty.
respect cultural values
92
How to apply Watson’s caring theory to listening?
Actually listening without judgment
93
How to apply Watson’s caring theory to spiritual care?
Respect their wishes and offer support such as arranging clergy visits or praying with a patient if they desire
94
What is Watson caring theory when caring for the family?
Show respect and inclusive video, regardless of their structure, culture, or other factors. Communicate openly with the family members.
95
How to apply Watson’s caring theory to cultural competence
include cultural practices into care plans
96
Define nursing research
The systematic, objective process of analyzing phenomena important to nursing. It’s used to develop knowledge to address issues in clinical practice, nursing education, and administration.
97
what was the historical shift from Heparin to saline?
due to evidence based practice, there was a meta-analysis that demonstrated saline was equally effective and safer than heparin to flush IVs. Therefore saline replaced Heparin. And it became the standard of care.
98
Why should nurses do research and how do they participate in research?
applying research findings can improve the quality of nursing practice.
Ways nurses participate in research:
1. identify ideas to research in clinical setting.
2. Design the study as qualitative or quantitative.
3. Collect data.
4. After analyzing the data, apply the research findings to Clinical practice.
99
What is the American nurses association standards?
set the standard for nursing research by committing to ethical and advanced research. They are also responsible for sharing peer-reviewed research findings with colleagues.
## Footnote
ANA = 'nay'; when research crosses ethical lines, the ANA say NAY
100
What is quality and safety education for nurses QSEN?
involves nursing research and it defines evidence-based practice.
Evidence based practice is defined as :
1. Having the best current evidence.
2. Clinical expertise.
3. patient/family preferences for care.
## Footnote
'QSEN' sounds like question. think of it as "q (question) + "sen" (Send for evidence)
101
What is Institute of medicine core competencies (IOM)?
employ evidence based practice
102
what is the safe and effective nursing care competencies SENC?
Validate and incorporate evidence based research into practice. Evaluate client outcomes using research tools.
## Footnote
'SENC' sounds like 'sense'; sensing if something is wrong to check the outcome
103
Nightingales nursing research- positives and negatives
- beginning of formalized nursing research
-nursing students conducted clinical research
- however her authoritarian educational tradition discouraged critical thinking which slowed development
104
Modern day nursing research - how does it compare to nightingale’s?
- There’s federal funding and private grants to promote nursing research.
- Research is disseminated all over: nationally, internationally, and in interdisciplinary journals
- higher education offered to increase the quality and diversity of nursing research
105
what does the American nurses association ANA do?
Establish research priorities
106
What does the national Institute of nursing research do NNR?
Federal agency under the national Institute of health. Identifies research themes and funding priorities.
107
What is the current nursing research priorities at the moment?
promoting health, preventing illness, manage, chronic conditions, palliative care, end of life, developing technological advancements.
108
what kind of things can Baccalaureate degree in nursing do
critique research for application to clinical practice, identify research problems, and participate in the planning and implementation of research studies, apply research findings to establish sound, evidence based clinical practice.
109
What are the four types of nursing knowledge and define each.
1. Theoretical knowledge: concepts theories, and principles guiding practice.
2. Practical knowledge: skills and procedures for patient care.
3. Ethical knowledge: understanding right and wrong in practice.
4. Self knowledge: awareness of one’s own values, beliefs, and biases.
110
What are the ways to acquire knowledge?
trial and error, authority and tradition, intuition and inspiration, logical reasoning, scientific method
111
What is authority and tradition?
Relying on expert advice
112
What is intuition and inspiration?
A sense of a gut feeling without concrete evidence
113
What is logical reasoning versus the scientific method?
logical reasoning is drawing conclusions by connecting known facts.
Scientific method is a process of collecting observable data to predict events. the scientific method uses empirical data collected using multiple method.
114
quantitative research is defined as
Numerical data like weight, length, temperature, race, gender, or test answers.
115
How is quantitative research collected?
surveys and close ended questionnaires, reading, scales, standardized, tests, checklists, bio Physical measures.
116
how is quantitative research analyzed?
statistical methods like chi-Square or regression analysis in an attempt to generalize findings to similar populations as the sample.
117
what were the framing ham studies?
A series of quantitative studies, influencing healthcare practices
118
What is the CURN project?
Focused on increasing research by nurses. A form of quantitative research.
‘Curn’= churning math
119
what is qualitative research? What’s an example of it?
Does not aim to generalize findings. Focus on understanding, phenomena, behaviors, perceptions, or ideas.
The non-study which focused on Alzheimer’s disease and aging by interviewing Catholic nuns and analyzing their diaries.
120
How to collect qualitative research data?
Interviews, focus, groups, journals, observations, audio, video, and Internet, examination of written documents, like diaries or letters
121
What are the five phases of research?
1. identify the research problem or question.
2. Choose a research design.
3. Collect data..
4. Analyze data using statistical methods for quantitative research, or identifying patterns and themes for qualitative research.
5. Apply the findings to improve clinical practice.
122
What are the rights of research participants in evidence based practice?
1. right to not be harmed
2. Right to full disclosure. (get all the facts)
3. Right to self determination. ( can choose to stop)
4. right to privacy and confidentiality.
123
what is the institutional review boards IRB?
They oversee ethical standards and research as required by the US department of health and human services. They are made up of healthcare professionals and members of the community. They protect research participants from harm and ensure that the research is ethical.
## Footnote
'I Review Bodies IRB' IRB reviews research studies involving bodies to keep them from harm and keep ethical
124
Explain what PICOT framework is
Patient or problem (old ladies w dementia)
Intervention (music therapy)
Comparison interventions (compared to standard care)
Outcomes (reduction in agitation?)
Time (over 6 week)
Forms a searchable question to based research on
125
do nurses have a legal responsibility to protect research participants from being harmed?
yes. Every patient has the right to not be harmed, right to full disclosure, right to self determination, rights of privacy and confidentiality.
126
how has nursing evolved from 1854 to 2050
Florence Nightingale changed unsanitary overcrowded conditions with limited resources and changed it to hygienic ventilated environment with nutritious meals to soldiers which reduce the mortality rate from 47% to 2%.
In 2021, found a relationship between low potassium and cardiac problems. Resolved when giving potassium to patient. demonstrated evidence. Teamed up with the provider.
future 2050 has probiotic cardiac surgery home health with Tele monitoring. Issue with discomfort of the family. Nurses identified anxiety spikes. They educated the patient family which resolved the anxiety. This prevented cardiac and respiratory complications.
127
what are the 4 competencies demonstrated by Florence Nightingale
patient center care, safety & quality improvement, teamwork, evidence based practice.
128
To inplement full spectrum nursing, a graduate nurse must integrate thinking, doing, and caring into all competencies. what is safe effective nursing care?
SENC framework. There are IOM core competencies.
- Thinking/knowledge: evidence based decisions and problem solving.
-doing/skill: interventions
-caring: respect for patient values and beliefs
SENC framework in practice combines traditional care with modern inter-professional collaboration and technology. It uses
combines critical thinking, communication, organization, leadership, advocacy, and technical skills.
129
Who is Dorothy Dix?
superintendent of US Army nurses during the Civil War. Organized nurses and hospitals to coordinate supplies for soldiers.
## Footnote
'Dix' = 'dick' as in mean. sargents are mean
130
Who is Clara Barton?
care near a Battlefield in tents. founder of the American Red Cross
## Footnote
two 'bars' make a cross.
131
Lillian Wald and Mary Brewster
Pioneers in public health nursing. Founders of the Henry Street settlement to combat disease among immigrants.
## Footnote
imagine drunk immigrant drinking brew and running into a wall (of poverty)
132
Edward Lyon
First male nurse commissioned as a reserve officer
133
Mary Mahoney
First African-American graduate in the US. Cofounded the national Association of colored graduates, which then later merch with American nurses association.
## Footnote
ma honor= mahoney, symbolize as highest honor
134
Lavinia Dock
nurse, feminist, and social activist. compiled the first manual for nurses. Contributed to the American Journal of nursing and helped establish the national league for nursing.
## Footnote
Dock; 'doc' document for nurses
135
There are many roles and functions of nurses. What is the function of a direct care provider?
Address all needs of the patient.
Ex: listen to lung sounds, administer medication, client teaching
136
What is a client advocate?
support clients healthcare decisions are protect from harm. For example, helping a client explain a decision to Family about declining chemotherapy.
137
What is a change agent?
Advocate for health improvements at all levels for example improving preschool nutrition programs.
138
What is the case manager?
Oversee client care, coordination, manage services for clients with (x) disease.
139
What is a nurse researcher?
Apply evidence base practice, and conduct research.
140
what is a client family educator?
Assess, plan, and implement teaching for clients in their families.
141
What is a nurse counselor
Support clients using therapeutic communication. For example, counseling on weight loss strategies.
142
what are some key nursing educational and regulatory trends
- nursing education has QSEN (quality and safety education for nurses), ANCN bachelorette essentials, and National League for nursing.
- nursing regulation has practice guided by professional standards, ethics, and regulatory frameworks that informs nurses about the current best practices.
143
AACN Bachla. essentials does what
Establish competencies for nursing students.
144
National League for nursing does what?
provide curriculum guidelines for vocational practical nursing education
145
Quality and safety education for nurses does what
Focus on core competencies
these competencies are client centered care, teamwork, evidence based practice, quality improvement & safety, and informatics
146
what was nursing defined as in 1973 by the international council of nurses?
Unique function of the nurse is to assist the individual, sick or well in the performance of those activities contributing to the health or recovery that he would perform if he had the necessary strength, will or knowledge.
147
What was nursing updated to by the ICN in 2002?
Nursing encompasses, autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and all communities. Nursing includes the promotion of health, prevention of illnesses, and the care of the ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation, and shaping health policy and inpatient and health systems management, and education are also key nursing roles.
148
what does the ANA define professional nursing as? In 2010
they defined it as having five characteristics:
- individualized
- Partnerships with others
- caring
- Use individualized care using the nursing process
- Linked to the professional work environment
Official statement is as follows :
nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering, through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.
149
what does a nursing definition provide?
It allows the public to understand the value of nursing, describe roles to other health professions, in that student nurses can understand their role.
150
What are important qualities for nurses? From the Bureau of Labor Statistics occupational outlook handbook.
critical thinking, skills, caring, detail oriented, organization, speaking skills, listening, skills, patience, competence, emotional stability, and physical stamina.
151
Is nursing a profession and why?
yes, Star criterion states that a profession is something where the knowledge of the group must be based on technical and scientific knowledge. The knowledge of the group must be evaluated by someone. And the group must have a code of ethics and a service that the group provides.
152
Is nursing a discipline?
yes. due to the theoretical and practical knowledge, it is a discipline. Theoretical boundaries or questions that arise from clinicals are then is investigated through research. The practical boundaries are the facts that dictate safe practice.
A disc has two sides to it
153
Is nursing an occupation?
yes. The conditions of practice are decided by the employer and the nature of work.
Key points (strengthens this):
- Standardized educational requirements
-Continuing education requirements
-Encourage more nurses to join working
-educate the public about the nurses job
154
what is the difference between a formal and an informal nursing education?
Formal education requires passing the NCLEX and attending an accredited program, as well as completing continuing education. You can start as an LPN, LVN, RN.
155
what is informal education?
gained through real world experience and direct observations. begins during your nursing education as a complement to formal education. Continues throughout the rest of your career.
156
where can an LPN or LVN work and in what conditions. How long does it take to become one.
Takes one year. Under RN provider supervision. Working nursing homes, hospitals, home healthcare, residential facilities. Takes the NCLEX PN
157
Registered nursing. How long does it take to get the degree, work they work
You can get your RN diploma which takes three years and is hospital based. model after Florence Nightingale.
you can get your associates degree in nursing which is called an ADN which states two years in community college and it was developed post World War II during the nursing shortage.
BSN and nursing research application and graduate education entry. Eight semesters.
RN to BSN for ADN nurses. Mrs due to more employers prefer preferring BSN.
A direct entry program allows you to get a masters degree or a doctorate.
158
What is a masters degree for in graduate nursing?
Nurse practitioner, educator, administrator. Takes two years.
159
what does a doctor of nursing practice do? (DNP)
Practice focus
160
What does a doctor of nursing science do? (DSN)
Research and practice focused
161
What does a doctor philosophy PhD do?
Research and knowledge generation
162
What is continuing education versus in-service education?
continuing education keeps nurses current in the clinical knowledge and is required for license renewal. In-service education is given by an institution which gives you specific training over policies or equipment use, and that is not typically counted towards CE requirements for license renewal.
163
explain the five stages of benders model of Clinical competence
-novice is a new learner with no clinical experience, Focus on task compilation
-Advanced beginner is a new grad relies on mentoring, but can recognize abnormal findings
-Competent is after 2 to 3 years in the same area
-Proficient well interpret assessment data to see the big picture while anticipating client needs.
-expert is a trusted advisor and highly skilled clinician that operates intuitively.
164
How is nursing regulated through nurse practice acts
they are enacted by each US state. They govern the laws inside of each state. this gives the state board of nursing the power to oversee all nurses.
- **define permitted things and prohibited things that nurses do. A.k.a. establish the scope of practice.
- Nursing program accreditation status.
- Decide what meets the qualifications for licensing as a nurse
- Make the rules
-enforce rules by investigating violations.**
165
What is required to be licensed as a nurse? Defined by nurse practice acts (compare in state and out of state requirements)
in state: graduate from an improved nursing program, pass the NCLEX.
out of state:
-licensed by endorsement a.k.a. you have to apply for the license and the new state every time.. mutual -recognition model allows practice across states due to the nurse licensure compact NLC
166
How is nursing regulated through standards of practice?
A standard of practice is an authoritative statement, describing competent nursing care and giving expectations for it. It provides the framework for evaluating yourself, your boss evaluating you, the public evaluating you. It allows for advocacy and continuing education development.
-outlines knowledge, skills and attitude KSA.
167
Again, what are nursing values and behaviors?
- primary concern is good of the client
- competent
-committment
-dignity and worth in everyone
- improve the profession
- collaborate
- code of ethics
- lifelong learning
168
to practice nursing, you must be licensed as a nurse by whom
The state board of nursing
169
What’s the ANA?
official professional organization for nurses. Evolved from the nurses associated alumni of the United States and Canada. It establishes standards of nursing and promotes licensure to enforce adherence to standards.
Published the American nurse. Advocates using local representatives to track legislation.
Define scope and standards of practice
170
what is the national league for nursing
Found it in 1893 as the American society of superintendents of training goals for nurses. First organization to focus on the standards of education for nurses. It also studies the nursing workforce and employees lobbying. Funds, nursing education, research, and supports faculty development.
Published nursing education perspectives
171
what is the international council of nurses ICN?
Represents over 20 million nurses globally from 130+ nations. EnSure quality nursing care worldwide. Improve the working condition of nurses globally.
172
what is the national student nurses Association nsna?
represents nursing students in the US. The student counterpart to the ANA. Publishes imprint magazine.
173
what is sigma theta towel international STIT?
International honor Society of nursing. Membership there includes clinical, education, and research communities. Nursing scholarships.
Published the journal of nursing scholarship.
174
what are specialty organizations?
they focus on either clinical specialties, group identification, or shared values.
175
Specialty organizations, focus clinically
Association of perioperative registered nurses, academy of MedSurg nursing, emergency nurses association
176
Specialty organizations that focus on group identification
National Association of Hispanic nurses, American Association for men and nursing, the American Association of the nurse attorneys, national American nurses Association.
177
what specialty organizations focus on shared values
Nurses Christian fellowship, nursing ethics network
178
higher percentages of BSN RN are linked to what
Lower complications and federal patient quality care. Smaller nurse to client ratios also result in positive client outcomes.
179
what is direct care versus indirect care?
Direct care involves personal interaction whereas in care is doing activities on behalf of a client, for example, ordering supplies or being an ethics community
180
what are four purposes of nursing care
Health promotion, illness prevention, health restoration, and end of life care
181
Where do nurses work?
60% of nurses work in the hospital. The rest work in outpatient, home healthcare, correctional facilities, military, schools, extended care, facilities, ambulatory care, centers, public health organizations.
182
What are five models of nursing care?
case method, functional nursing, team nursing, primary nursing, differentiated practice
183
What is the case method?
it is total care. One on one. This is done in intensive care unit, labor, and delivery, private duty care.
Close nurse client relationship.,
greater autonomy for the nurse
Quick response to the client needs
184
What is functional nursing?
Care divided into tasks with each assigned to staff with the right skills.
our ends get complex treatments. LPNs get medication administration. Nursing assistants give the bed bath and making beds.
-care is fragmented, however economical and efficient.
185
What is team nursing?
A nurse (RN or LPN) is paired with an unlicensed assistive personnel
-Economical with reduce fragmentation. Helpful for nursing shortages.
186
What is primary nursing?
one nurse manages the care of a group of clients
The primary nurse assesses and develops the care plan while the associate nurses deliver care and implement the plan when the primary nurse is unavailable
187
what is differentiated practice?
Nurses have a developed portfolios of their competencies and then are assigned clients
188
What is acute care?
Sudden urgent or emergent health episodes that can lead to death or disability without rapid intervention
189
What are domains of acute care?
trauma, acute care, surgery, emergency, urgent, short term stabilization, prehospital care, critical care
190
what are long-term support services?
It can be both inpatient or outpatient. Inpatient is when clients are admitted for 24 hour care or longer. Outpatient is when they do not stay overnight.
Extended care facilities, ambulatory care centers, home healthcare agencies.
it is human assistance, technology, or environmental modifications that serve someone on a regular or intermittent basis.
191
name six different care settings
hospitals, extended care facilities, ambulatory care centers, home healthcare agencies, community public health centers, independent living facilities.
192
Describe hospitals, the staff and their key features
they are the most expensive and frequently used. They can give emergency care, diagnostic care, specialized units like the ICU, pediatrics, surgical, maternal newborn care.
Can employee a variety of healthcare professionals, like nurses, hospitalist, case managers, Allied health therapist, pharmacist.
193
what are the extended care facilities?
They provide long-term care, a few months to a whole lifetime. They used to be offered in hospitals, but are now provided and extended care facilities due to shorter hospitals stay.
Someone going to an extended care facility can either receive skilled care or custodial care.
194
What is skilled care in an extended care facility?
A service by a train professional for a limited period and clients are expected to improve with treatment
195
What is custodial care at an extended healthcare facility?
Is this with activities of daily living such as bathing, dressing, eating, and ambulation. These clients only need supervision but not hospitalization.
196
What’s an example of an extended care facility?
Nursing homes, rehabilitation centers, assisted living facilities.
197
What do nursing homes do
Provide custodial care for people requiring continual supervision and offer recreational activities and salon services
The residents are people with severe illness, disability, or cognitive impairment who need full-time medical assistance and monitoring
198
what is a rehabilitation center
Extended care for physical and mental health recovery. Common services include drug, alcohol, rehabilitation, physical therapy, recovery from a stroke or heart attack.
199
what is an assisted living facility as compared to a nursing home
assisted living facility is for older adults, needing assistance with meals, housekeeping, or medication. Very limited nursing presence as skill care is not typically required. An assisted living facility provides personal care, but does not need as much care as at a nursing home.
200
What is an ambulatory care center?
outpatient facilities offering walk-in same-day or specialized services.
Urgent care, outpatient therapy centers, some hospitals or medical offices. Is cost-effective.
201
What is a home healthcare agency
going to the clients home after hospitalization. Done by nursing staff, physical therapist, respiratory therapist, or home assistance programs.
202
What is a community public health center?
A center that offers care at risk populations. It could be a school days program or service for the homeless. It improves the community health. This could be done at shelters, school, workplace, churches.
203
what is an independent living facility?
design for seniors 55 and older who are independent but prefer community living. afford them socialization opportunities, recreational activities, fitness centers, transportation. The nurses there provide periodic health, screenings, and health information.
204
what are the three main types of healthcare categorization?
primary services which focuses on health, promotion and illness prevention..
secondary services which focuses on early diagnosis and treatment of diseases
Tertiary services which focuses on long-term rehabilitation and end of life care
205
what is health promotion?
Enhancing physical, mental and social well-being
206
What is illness prevention?
Reducing risks of disease and comorbidities
207
what are four levels of health promotion
1. individual level. Council a pregnant client about prenatal nutrition.
2. group or family level. Teaching nutrition in family educational programs
3. community level. Advocating for billboards, promoting prenatal care and nutrition.
4. society level. Collaborating internationally to establish global prenatal nutrition standards.
208
what are examples of illness prevention?
Teaching hand hygiene. Promoting smoking cessation. administering pneumonia, immunizations and encouraging diets that are nutritious to boost immunity.
209
our secondary services is typically performed in
outpatient centers, surgery centers, and offices in order to catch early diagnosis and treatment of diseases.
210
What role is a physician supposed to be?
Diagnose and treat illnesses. Can work independently. Can work in a hospital or a group. Can work as a hospitalist.
211
What is a nurse practitioner role?
Provide broad medical and nursing care independently or collaboratively
212
What is a physician assistant?
Work under physician supervision to diagnose and treat. Have some restrictions depending on the state laws as what they can prescribe.
213
What is the role of an RN?
Assess clients, administer treatments, educate clients, modify care plans based on client responses.
214
What is an LPN?
Provide non-complex care under an RN supervisor, administer medication, and communicate client responses.
215
What is an unlicensed assistive personnel
Provides custodial care under a nurse or provider direction. These can be nursing assistants, aids, technicians. They cannot legally refer themselves as nurses.
216
Name seven types of therapists.
PHYSIATRIST; rehab leaders, focusing on mobility and strength.
Physical therapists ; address, muscle and bone rehab
Occupational therapist; help regain independence and daily activities
respiratory therapists; use leisure activities for well-being
speech and language therapists; assist with swallowing and speech impairments
Recreational therapist; leisure activities for well-being
Marriage and family therapists; provide counseling to individuals, families and groups.
217
What is a technologist?
Perform specialized tasks in diagnostic centers, hospitals, and emergency facilities. For example, lab and radiology technologist.
218
What is a registered dietitian?
Apply nutrition science to plan treatments and promote health.
219
What is a social worker?
Provide psychosocial support, assist with post discharge planning, and coordinate continuity of care
220
Alternative care providers
Chiropractors, naturopaths, herbalists
221
Name three government financing programs
medicare, Medicaid, and children’s health insurance program (chip)
222
What does Medicare do?
Established under title 13 of the Social Security act. Covers individual 65 and older, or younger people with permanent disabilities. It’s funded by the payroll taxes. People still have to pay premiums. It offers very limited coverage if someone needs care long-term.
223
What is Medicaid?
established under title 19 of the Social Security act. Provides healthcare for those with low income and limited resources. The joint federal state program offer eligibility and benefits.
There is tons of coverage from Medicaid. it covers the entire cost of prescription drugs, long-term care, and skilled care. There’s not usually a deductible or a co-pay
224
What is children’s health insurance program (chip)?
The joint federal state program. It offers health insurance for kids. Sometimes there is a gap between what Medicaid will cover and what the parents can offer. Chip picks up the gap and gives kids health insurance.
225
What barrier is created from the high cost of healthcare?
early screening and preventative care inhibited.
226
What are the upside and downsides of employment based plan?
They offer much more benefits to employees but shift increasing costs to workers
227
What are the upsides and downsides of public programs?
They provide critical coverage to vulnerable populations, but our subject is state variation and budgetary constraints
228
What was the impact of the affordable care act?
it was implemented in 2010. Reduction of uninsured from 44,000,000 to 26,000,000 3years later.
Without coverage people often forgo screenings and rates of chronic illness goes up
229
How did Medicare, and increased costs impact hospitals over the years since 1983?
when Medicare was founded it costed 3 billion a year. In 1983, it increased a 37 billion. They had to pay for Medicare somehow.
The DRG system (diagnostic related groups):
So they gave hospitals a flat rate payment per patient/case. As a result of this, hospitals min maxed the system by forcing people out of the hospital sooner, under the care of cheap nursing staff (UAP), understaffed nurses, and increase the premiums for patients reducing access to care for many.
230
what is a managed care organization? 4 TYPES
HMO health maintenance organizations, PPO preferred provider organization, point of service POS, integrated delivery network IDN
231
what are the key points of an HMO
fixed monthly payment,
primary care providers, manage all referrals and care.
Least expensive, but there’s a restriction as to who you can be referred to
232
Preferred provider organization?
read her choice among and network providers however there’s increased premiums deductibles and coinsurance compared to HMO. Out of network care is also available, but there’s a higher cost to.
233
What is point of service?
includes both features of HMO and PPO. Like HMO there’s a primary care physician that has to refer you. Whoever like a PPO, you can get limited out of network coverage with higher copayments and coinsurance
234
what is integrated delivery network IDN
Consolidation of services into one system. Provider facility and pharmaceuticals are all within the network. Biggest focus on teamwork and collaboration.
235
healthcare reform direction
in the direction of Universal access, skilled workforce, accessible financially to those with limited resources, an optimized services with a priority on community primary and preventative care.
Those are the ANA principles for health system transformation since 2016
there’s also a transition to perspective payment system which creates opportunities for a nurse leaders
236
what is work redesign?
As a part of healthcare reform, work redesign looks the level of care required, and the mix of personnel necessary to achieve it. It formed new concept such as critical pathway and case management.
237
Critical pathway is what?
Allows a health professional team to give the highest quality most efficient care to reduce the clients length of stay.
A.k.a., they are paid differently so that the patient insurance isn’t being charged for length of stay or time spent.
238
What is case management
case managers, identify resources, and manage outcomes.
They are employed by hospitals, home health, agencies, and insurance agents to ensure that a client receives resources when hospitalized and after discharge.
239
What are continuous quality improvement programs?
CQI focuses on ongoing quality improvement as a goal. Hospitals and healthcare facilities cannot simply give the bare minimum. they must give excellent care.
240
what are the three steps of quality improvement?
Process reviews (set a goal or guideline that ensures quality care)
Outcome reviews (evaluate if goal reached)
Structure reviews (if goal not achieved, figure out why by doing an audit.)
241
what is SENC?
Safe effective nursing care
it is quality improvement competency.
It is setting up the structure, process, and outcomes to deliver quality care
242
What were some societal factors influencing nursing practice?
The national economy, growing population of older adults, changes in healthcare consumers, legislation, the women’s movement, collective bargaining.
243
what happened to the national economy?
Health insurance was linked to full-time employment until the 2008 recession when unemployment was higher. This increased premiums for those who still had insurance and there was a greater pressure on emergency departments for healthcare. there was a greater need for APRN a.k.a. nurse practitioners.
The post affordable care act expanded health insurance for the unemployed.
Because of the recession, retired older nurses remained working, and this created a shortage for new grad nurses. Once the economy recovered, the older nurses were able to retire, and suddenly there was a shortage of RNs.
in 2018, RNs are at 3.1 million. Whereas physicians are at 800 K, pharmacist are at 300 K and nurse practitioner APRN are at 250 K.
244
Explain the growing population of older adults, impacting nursing
in 2017 there is 50, million individual 65 and up. In 2035, 65 number children under 18. In 2060, there’s 94 million projected age 65+ and there will be less working age adults per retired adult.
This will stream the federal state revenues for healthcare programs and increase demand on the healthcare system.
245
How has patient awareness and engagement impacted nursing?
patients want a greater involvement in their healthcare plan and they have more information that they can access to because of the Internet. Patients dont know what is valid reliable information.
246
how is Patient direct to consumer marketing impacted nursing?
Big Pharma advertises medication and therapies directly to patients. Nurses must educate the patients with evidence-based information. Avoiding undo influence from consumer trends.
247
What are the laws influencing nursing care?
confidentiality protecting client records.
emergency treatment, emtala gives emergency treatment to whoever needs it
inform consent
Dignified death via living Wells and advanced directives
248
How did the women’s movement impact nursing?
historically nurses were only for unmarried women. Society, Broad, and women’s career options beyond nursing, teaching and clerical roles. Now the profession is no longer viewed as exclusively for women.
249
How has collective-bargaining impacted nursing?
Collective bargaining as a negotiation process conducted by unions or organizations. As a result, nursing has improve wages, benefits, and working conditions.
250
begin @ pg 195 to pg 233
ch 2
251
What is clinical judgment?
Assess and recognize evidence of client problems. Interpret and prioritize responses. Take action, evaluate outcomes, and modify interventions. Consider the context of staffing, resources, individual skill level.
| USES CRITICAL THINKING
252
what are four types of nursing knowledge and what are they?
1. theoretical knowledge is knowing why. The path, diagnostics, comment, treatments, facts, and evidence space theories.
2. Practical knowledge is knowing how. Application of a procedure.
3. Self knowledge is your values and biases that impact decision-making.
4. ethical knowledge is knowledge of moral principles and ethical decision-making which fulfills obligations.
253
how are the four types of nursing knowledge significant and making sound clinical judgment?
It integrates all four in order to have sound clinical judgment.
254
what is the Tanner model of Clinical judgment? What are its 4 aspects?
noticing, interpreting, responding, reflecting.
Noticing means identify client needs. Interpreting means to use reasoning. Responding means seeking action. Reflecting means learning from actions.
255
what are the three types of reasoning under the Tanner model of interpreting?
analytical reasoning means data driven decisions common for new nurses
Intuitive reasoning means experience based instinct
narrative reasoning means understanding client perspectives for personalized care
256
Under the Tanner model Clinical judgment, what is reflection in action versus reflection on action?
Reflection in action means real time evaluation. Reflection on action means post action analysis for future improvement.
257
explain the Lasater Clinical judgement Rubric (LCJR)
Evaluates development of clinical judgment across 11 dimensions linked to tanners clinical judgment model. It scores of students based on their simulation or clinical performance in order to identify areas to grow.
dimensions are categorized under four aspects.
1. Noticing - focused observations, recognize deviations, seek info
2. Interpreting - prioritize and make sense of data
3. Responding - clear communication and well planned skillful action
4. Reflecting - Reflect in action and reflect on action
levels of clinical judgment :
- beginning: 11
- developing: 12-22
- Accomplished: 23- 33
- Exemplary: 34-44
258
explain the national council of state boards of nursing (NCSBN) clinical judgment model (CJM)
Addresses the preparation to practice-gap and new nurses.
five layers :
1. Layer 0: clinical decisions made to address client needs
2. Layer 1: clinical judgement outcome
3. Layer 2: The cycle of forming a hypothesis via recognize patterns, recognize cues, and then refine decisions. More cycles for novices, fewer for experienced nurses.
4. Layer 3: Solid knowledge base to recognize patterns, analyze cues
5. Layer 4: individual or environmental factors that complicate. Individual being knowledge, skill, prior experience. Environmental being time constraints, task complexity, and resources.
259
what are the similarities of the key LCJR and CJM models?
They both emphasize recognizing cues, analyzing data, and taking action. Reflection is both integral for improving practice.
260
What are the differences between the LCJR and CJM models?
LCJR focuses on performance levels during specific scenarios.
CJ model provides a broader framework for clinical judgment development overtime
261
What is Clinical reasoning
The process of taking information from multiple sources and integrating experiences to develop a plan. Going through cycles until confidence in the diagnosis and approach is reached.
steps :
1. Assess client and collect data.
2. Formulate hypothesis about the client problem.
3. Analyze data and refine hypothesis.
4. Develop a care plan based on evidence.
5. Evaluate and adjust interventions as needed.
262
What are some ways for developing Clinical reasoning
Algorithms, reflective, journaling, thinking aloud, simulation, and case studies.
263
What is the evidence supporting clinical reasoning development?
Experiential learning theory, simulation, fosters higher clinical judgment scores, compared to traditional simulation, based learning. It creates cognitive, metacognitive, psychomotor, and affective learning.
264
what is clinical reasoning versus critical thinking?
Critical thinking includes abstract reasoning, and is essential for clinical reasoning. It is broader and scope. It requires openness and a desire to seek the truth.
clinical reasoning applies knowledge and experience to a specific scenario.
265
what are some critical thinking attitudes?(8)
intellectual autonomy, intellectual curiosity, intellectual humility, intellectual empathy, intellectual courage, intellectual perserverance, fair mindedness, confidence in reasoning.
266
what is intellectual autonomy?
Independent evaluation of ideas before accepting or rejecting
267
What is intellectual curiosity?
Inquisitiveness about new ideas and knowledge
268
What is intellectual curiosity?
Inquisitiveness about new ideas and knowledge
269
What is intellectual humility?
Seeking help in a reevaluating conclusions when needed
270
What is an intellectual empathy?
Understanding other perceptions and emotions
271
What is intellectual courage?
Examining and questioning one’s own belief
272
what is intellectual perseverance?
Pursuing effective solutions despite challenges
273
what is an intellectual fair mindedness?
Making unbiased, impartial judgments
274
what is confidence in reasoning?
Trusting one’s ability to think logically and make sound decisions
275
Why would critical thinking be important for nurse?
Nurses have to deal with complex situations with comorbidities, assessing for responses, and seeing how effective the treatments are, and respond to each patient w/ unique differences, beliefs, roles, and lifestyle.
276
What are the five points of the critical thinking model and what does it do?
It’s purpose is to guide decision-making by organizing, thinking into five categories, allowing reflection before and after actions.
1. Contextual awareness. (what influences the situation)
2. Inquiry. (is my data accurate?)
3. Consider alternatives. (which one is most reasonable)
4. Analyze assumptions. (beliefs and values underlying decisions)
5. reflect skeptically and decide. (what could be done different next time)
277
Name eight critical thinking attitudes
intellectual autonomy, curiosity, humility (know limits), empathy, courage, perseverance, fair mindedness (imparial judgements), confidence, and reasoning.
278
what is caring and what are components of caring? there are five components.
caring is relational, not routine. A preserved human indignity and avoids treating client as objects.
1. Knowing: what do events mean to the clients life
2. Being With: emotionally present
3. Doing For: help with tasks
4. Enabling: support through significant life changes
5. Maintaining Belief: encourage resilience
279
What is full spectrum nursing
combines, thinking, doing, caring, and client context to make sound judgments. integrate critical thinking with clinical reasoning and practical knowledge to address client situation individually and culturally sensitive.
1. Thinking: critically thinking & reasoning guide knowledge application
2. Doing: Practical skills
3. Caring: empathy
4. Client context/situation: physical, psychosocial, cultural, or environmental factors
