Note cards from Week 2 reading Flashcards
evidence- based practice (EBP)
evidence based nursing, occurs when the nurse can “integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care” pg 26
what goes into EBP?
Best evidence + clinical expertise + patient values and preferences = EBP
research
entails using formal and systematic processes to address problems and answer questions.
cultivating a spirit of inquiry
nurses need to be curious and willing to investigate how various practices compare and which might be best for a specific client.
ask clinical questions
for consistency and efficiency, nurses should state the question in a standard format such as PICOT
search for the best evidence
in the previous step, key terms are identified that facilitate identifying relevant evidence in the literature
critically appraise the evidence
several toolkits or schema are available to assist the nurse in determining the most valid, reliable, and applicable evidence. in some cases, relevant studies may already have been synthesized.
integrate the evidence with clinical expertise and client/family preferences and values
evidence must not be automatically applied to the care of individual clients. each nurse must determine how the evidence fits with the clinical condition of the client, available resources, institutional policies, and the client’s wishes.
implement and evaluate the outcomes of the intervention
the nurse gathers all relevant data that may indicate whether or not the intervention was successful
value system
people organize their values internally along a continuum from most important to least important
beliefs (opinions)
are interpretation or conclusions that people accept as true. based on more faith than fact
may only last briefly
attitudes
mental positions or feelings towards a person, object, or idea. lasts over time.
values
enduring beliefs or attitudes about the worth of a person, object, idea, or action.
pg 73
essential nursing values: altruism
a concern for the welfare and well-being of others.
essential nursing values: autonomy
the right to self-determination. when the nurse respects patient’s rights to make decisions
essential nursing values: human dignity
respect for the inherent worth and uniqueness of individuals and populations.
essential nursing values: integrity
acting in accordance with an appropriate code of ethics and accepted standards of practice.
essential nursing values: social justice
acting in accordance with fair treatment regardless of economic status, race, ethnicity, race, sexual orientation, etc.
professional values
are acquired during socialization into nursing from codes of ethics, nursing experiences, teachers, and peers.
values clarification
a process by which people identify, examine, and develop their own individual values.
bioethics
ethics as applied to human life or health
nursing ethics
refers to ethical issue’s that occur in nursing practice
morality
usually refers to private, personal standards of what is right and wrong in conduct, character, and attitude.
ethics
a method of inquiry that helps people to understand the morality of human behavior, the practices or beliefs of a certain group, and the expected standards of moral behavior of a particular group as described in the groups formal code of professional ethics.
moral development
the process of learning to tell the difference between right and wrong and of learning what ought and ought not to be done.
principles based (deontological) theories
involve logical and formal processes and emphasize individual rights, duties, and obligations
utilitarianism
one form of consequentialist theory, views a good act as one that is the most useful- that is, one that brings the most good and the least harm to the greatest number of people. this is called the principle of utility.
relationship based caring theories
stress courage, generosity, commitment, and the need to nurture and maintain relationships.
consequence based teleological theories
look to the outcomes (consequences) of an action in judging whether that action is right or wrong.
moral rules
specific prescriptions for actions
autonomy
refers to the right to make one’s own decisions.
nonmaleficence
the duty to “do no harm”
beneficience
means doing good.
justice
frequently referred to as fairness
fidelity
means to be faithful to agreements and promises
veracity
refers to telling the truth
accountability
answerable to onself and others for ones own actions
responsibility
refers to the specific accountability or liability associated with the performance of duties of a particular role.
code of ethics
a formal statement of a groups ideals and values
read application of a bioethical decision- making model
page 81-82
active euthanasia
involves actions to bring about the clients death directly, with or without client consent
assisted suicide
giving clients the means to kill themselves if they request it
passive euthanasia
commonly referred to now as withdrawing or with-holding life sustaining therapy, involves the withdrawal of extraordinary means of life support such as removing a ventilator or withholding special attempts to revive a client.
advocate
one who expresses and defends the cause of another
health care system
the totality of service offered by all health disciplines
primary prevention:
health promotion and illness prevention
secondary prevention
diagnosis and treatment
tertiary prevention
rehabilitation, health restoration, and palliative care
types of health care agencies examples
public health- health departments physicians offices ambulatory care centers- occupational health clinics hospitals subacute care facilities- generally the individuals condition doesn't require high monitoring extended (long term) care facilities retirement and assisted living centers rehab centers home health care agencies day care centers- for adults and children who can't be left alone rural care hospice services crisis centers mutual support and self help groups
safety- net hospitals
provide a significant level of care to low-income, uninsured, and vulnerable populations.
examples of providers of health care
nurse, case manager, dentist, emergency medical personnel, any therapist, pharmacist, social worker
licensed vocational nurse or licensed practical nurse
provides direct client care under the direction of an RN, physician, or other licensed practitioner.
factors affecting health care delivery
increasing # of older adults advances in technology economics women's health uneven distribution of services access to health insurance homeless and the poor health insurance portability and accountability act demographic changes
factors contributing to the health problems of the homeless and the poor
- poor physical environment
- inadequate rest and privacy
- improper nutrition
- poor access to facilities for personal hygiene
- exposure to the elements
- lack of social support
- few personal resources
- questionable personal safety
- inconsistent health care
- difficulty with adherence to treatment plan
intent of HIPAA regulation
- provides individuals with more control over their health info
- establishes limits for appropriate use and release of health care info
- requires health care providers and their agent to comply with safeguards to protect individual privacy related to health care info
- delineates a set of civil and criminal penalties holding HIPAA regulation transgressors accountable for actions if a client’s health care privacy is violated
case management
describes a range of models for integrating health care services for individuals or groups.
- assessing clients and their homes and communities
- coordinating and planning cost-effective client care
- collaborating with other health professionals
- monitoring client’s progress
- evaluating client outcomes
critical pathway
a plan or tool that specifies inter-professional assessments, interventions, treatments, and outcomes for health-related conditions across a timeline
team nursing
the delivery of nursing care to individual clients by a group of providers led by a professional nurse.
Payment sources
medicare and Medicaid supplemental security income children's health insurance program women, infant, and children program prospective payment system private insurance group plans
medicare
for 65 years of age and older
medicaid
for people who require financial assistance, low income
coinsurance
the percentage share of a government approved charge that is paid by the client; the remaining percent is paid by the plan.
supplemental security income (SSI) benefits
people with disabilities or those who are blind, clients often use this to purchase medicine or cover costs of extended health care
diagnosis- related groups (DRGs)
reimbursement is made according to this classification system
individual health
dimensions of individuality include the person’s total character, self identity, and perceptions.
individuality
to help clients attain, maintain, or regain an optimal level of health, nurses need to understand clients as individuals.
concept of holism
nurses are concerned with he individual as a whole, complete, or holistic person. not as an assembly of parts and processes. the concept emphasizes that nurses must keep the whole person in mind and strive to understand how one area of concern relates to the whole person.
pg 245
Healthy People 2020
provided a framework for national health promotion, health protection, and preventive service strategy.
health promotion
“behavior motivated by a desire to increase well-being and actualize human health potention” definied by healthy people 2020
disease prevention/health protection
behavior motivated by a desire to actively avoid illness, detect it early, or maintain functioning within the illness.
Health promotion VS Health Protection
Health Promotion:
not disease oriented
motivated by personal positive approach to wellness
seeks to expand positive
Health Protection: Illness or injury specific motivated by avoidance of illness seeks to stop the potential for health occurrence of insults to heal and well being pg 249
Behavior- Specific Cognitions and Affect
read on page 251-252
Stages of Health Behavior Change
precontemplation- the person doesn’t think about changing in the next 6 months
contemplation- person acknowledges a problem, gathers info, plans to change in the near future (next 6 months)
preparation- intends to take action in the immediate future (a month)
action- actively implements behavioral and cognitive strategies
maintenance- the person strives to prevent relapse by integrating newly adopted behaviors into his or her lifestyle.
termination- the ultimate goal; the point at which the individual has complete confidence that the problem is no longer a temptation or threat.
pg 253
nurse’s role in health promotion
-model healthy lifestyle behaviors and attitudes
- teach clients self care strategies
- educate clients
more in box on page 253
