Nur 300 Final exam Flashcards
Situation
What is the situation you are calling about?
Identify self, unit or setting, and patient name
What is going on with the patient that is a cause for concern. A concise statement of the problem
Background
What is the pertinent clinical background information?
Admitting diagnosis and date of admission
List of current medications, allergies, IV fluids, etc.
Most recent vital signs
Lab results
Medical history
Recent clinical findings
Advance Directive/code status
Styles of Conflict Management,
Discomfort
“pick your battles”
Avoidance
Styles of Conflict Management,
Surrender our own needs
Likely will resurface
Accommodation
Styles of Conflict Management,
Domination
Aggressive
Competition
Styles of Conflict Management,
Solution-oriented
Collaboration
Symbolic representation of a phenomenon or set of phenomena
Concept
Set of abstract and general concepts that represents a phenomenon of interest
Conceptual Model
Global concepts specific to a discipline that that are philosophically neutral and stable
Metaparadigm
A designation of an aspect of reality
Phenomenon
Nursing’s Metaparadigm
Person
recipient of nursing care
Environment
internal and external context
Health
Dynamic equilibrium of all components of person and environment
“nursing is an intellectual discipline and not only skills used in the care of people who are sick.”
Jacqueline Fawcett RN, PhD, FAAN
Theory
“thoughtful examination of a phenomenon”
“defines relationships among its concepts, assumptions, and propositions
“provides a conceptual foundation for nursing research”
provides a framework/guide for practice
generalizable
Mental idea of an abstract phenomenon
Construct
The whole is greater than the sum of its parts
Bertalanffy
Grand Theory
Key concepts and principles of a discipline
General and abstract
Cannot be tested empirically
more discrete aspects of a phenomenon
applicable to many nursing situations
operationalized to nursing practice
can be tested empirically
relational statements
Peplau’s theory of interpersonal relationships
Leininger’s theory of transcultural nursing
Mid-Range Theory
2 Grand Theories
Newmans and Parses
Classification of Theory
Grand
Middle Range
Practice
Key concepts and principles of a discipline
General and abstract
Cannot be tested empirically
Grand Theory
client is an open system that responds to stressors in the environment
Newman’s theory of expanding consciousness
quality of life from each person’s own perspective as the goal of nursing practice
Parse’s theory of human becoming
Newman’s Theory- ___ conditions can be considered a manifestation of the total pattern of the individual
pathological
Newman’s Theory- Removal of the
pathology in itself will not change the pattern of the indivdual
2 mid range theories
Peplau’s theory of interpersonal relationships
Leininger’s theory of transcultural nursing
Parse’s Theory- Person: Open being who is more than and different from
the sum of the parts
Parse’s Theory- Environment
Everything in the person and his experiences
Inseparable, complimentary to and evolving with
Parse’s Theory- Health:
Open process of being and becoming. Involves synthesis of values
Parse’s Theory- Nursing:
A human science and art that uses an abstract body of knowledge to serve people
Parse’s Theory- Application to practice: It does not seek to
“fix” problems Ability to see patients perspective allows nurse to “be with” patient and guide them toward desired health outcomes. Nurse-person relationship cocreates changing health patterns
Peplau’s theory- The purpose of nursing is to help others identify their felt
difficulties
Peplau’s theory- Nurses apply principles of human relations to the problems
that arise at all levels of experience.
Peplau’s theory- Nursing is therapeutic in that it is a healing art, assisting an individual who
needs healthcare
Peplau’s theory- Nursing is an interpersonal process because
it involves interaction between two or more individuals with a common goal
Peplau’s theory- The attainment of goal is achieved through the use of
a series of steps following a series of pattern.
Peplau’s theory- The nurse and patient work together so both become
mature and knowledgeable in the process
Leininger’s theory combines ___ perspective with nursing’s focus on caring
anthropological
Mission
To protect the public by fostering high standards of professional licensure, practice, and discipline
Legal documents developed at state level
Nurse Practice Act
Most important statutory laws governing the provision of professional nursing care
Nurse Practice Act
Scope and standards of professional nursing practice that define nursing’s domain
Nurse Practice Act
Types of titles and licenses
Requirements for licensure
Grounds for disciplinary action, other violations and possible remedies
Nurse Practice Act
Licensure vs. Registration
License is for life
Reregister every
3 years
Education program standards
At least 2-year degree in general professional nursing at qualifying university
Training identification and reporting of child abuse
Training in infection control
Legally bound by principle of Tort law to provide
reasonable standard of care – level of care that a reasonably prudent nurse would provide in a similar situation
HIPAA covered entities:
Providers
Health insurance plans
Health care clearinghouse
Kubler-Ross
came up with the 5 stages of dying
5 stages of dying:
Denial Anger Bargaining Depression Acceptance
Palliative care is a clinical approach to improve
the quality of life for clients and families dealing with a life threatening illness.
Palliative care clients may still be getting
active treatment for their disease to control symptoms and improve quality of life.
The focus of palliative care is
managing symptoms and having a good death, rather than active treatment.
the personal emotions and adaptive process a person goes through in recovering from loss.
Grief
Lindermann
studied the grief process. He said that grief can be immediate or delayed.
Lindermann’s 3 methods of supporting grieving patients,
- empathetic communication
- honesty
- tolerance of emotional expression
Lindermann said that absent or exaggerated grief are known as
“pathological or complicated grief”
Engel
Added to Lindermann’s theory of grief
Engel had 3 phases of grief:
- shock/disbelief
- developing awareness
- restitution
The restitution phase is when the person
adapts to life without the deceased.
States that grieving involves integrated the past memories of the deceased into the present life.
Florczak
somatic distress that occurs in waves with feeling of tightness in the throat, shortness of breath, an empty feeling in the stomach, and mental pain
Acute grief
an emotional response that occurs before the actual death
Anticipatory grief
occurs while a person is still alive, in relation to a dibilitating disease. For example, sorrow in the parents of a mental ill child.
Chronic sorrow
a form of grief that unusually intense or long.
Complicated grieving
death that is free from unavoidable suffering, follows the patient’s/family’s wishes, and is consistent with clinical/ethical standards.
Good Death
More traits of a good death:
- symptom relief
- open decision making
- knowing what to expect
- having a sense of completion
- contributing to others
- receiving affirmation as a whole person
Grief felt by nurses when their client dies
Disenfranchised grieving
emotionally drained to the point that you can’t care about other patients
Compassion fatigue
free from disease, able to function normally, well being, health lifestyle
health
an interactive education and support process
Health promotion
Health promotion lets people reach
their potential by improving their environment and lifestyle.
concerned with identifying risk factors and protective factors in order to manage the risk of illness
Disease prevention
a person’s subjective experience of satisfaction with his life
Well-being
Areas of well-being include:
intellectual, emotional, occupational, spiritual, social, and physical
3 major trend influencing healthcare in the U.S.
- demographic changes
- advances in technology
- Globalization
Overarching goals of Health People 2020:
- Eliminate preventable disease
- Achieve health equity (for example, eliminate disparities)
- promote healthy environments
- promote health in all stages of life
Pender’s Health Promotion model-
Looks at the factors in a person’s life that can influence their decision to make choices about healthcare. These factors can include internal things like, doe the client see a benefit to the healthcare decision. It can also be an external factor like being required to get a vaccine in order to attend public school.
Prochaska’s Transtheoretical Model-
Includes 5 stages in the changing process:
Precontemplation Contemplation Preparation Action Maintenance
client doesn’t think there’s a problem, not considering change
Precontemplation
Client thinks there may be a problem, going back and forth about a decision
Contemplation
Client decides there is in fact a problem
Preparation
Motivational Interviewing
Nurse and client work together to set goals.
It’s effective because of how involved the client is; the client is responsible for the success of the healthcare plan.
Nurse and client work together to set goals.
It’s effective because of how involved the client is; the client is responsible for the success of the healthcare plan.
Motivational Interviewing
Came up with the idea of self-efficacy, which is a person’s belief that they are capable and able to make changes. They have confidence in themselves
Bandura
Bandura
Came up with the idea of self-efficacy, which is a person’s belief that they are capable and able to make changes. They have confidence in themselves
____ and motivation go hand in hand- they increase each other
Self-efficacy
Bandura believes that learning is a social process. Learning involves-
physical motivators
social incentives
cognitive motivators
Bandura, Physical motivator
remembering pain and wanting to avoid that
Bandura, Social incentive
praise
Bandura, Cognitive motivator
internal thought process associated with change
Precede-Proceed Model of community education
- health is multidetermined
- health teaching must be multidimensional and participatory to be effective
The “Precede” part refers to the
planning
The “Proceed” part refers to the
resources and other practical issue needed to implement community education.
Domains of Learning
Cognitive
Affective
Psychomotor
cognitive domain
the focus when the client has a knowledge deficit. For example, understanding the pathology of the disease you’re diagnosed with
Cognitive learning allows for the clarification of information and
correction of misinformation
affective domain
has to do with the client’s emotional response. This domain is important when there are issues with compliance and acceptance. For example, teaching in the affective domain could involve getting the client to emotionally accept the fact that they are ill and that it’s their responsibility to care for themselves.
Psychomotor
teaching skills, like self injecting insulin
Carl Rogers
Said that teaching must be lerner-center. The teacher should start at the level of the learner and make adjustments specifically for that learner
Said that teaching must be lerner-center. The teacher should start at the level of the learner and make adjustments specifically for that learner
Carl Rogers
Rogers also said that the learner being an active participant is important and that they
must be responsible for the education
Andragogy
education of adults
Pedagogy
education of children
the reward used to reinforce a behavior should be something the learner specifically likes.
Premack principle
Behavioral strategies
- Modeling
- Shaping
- Chaining
Shaping is when you
break down a desired behavior into small steps and gradually combine them
Chaining is when you
link individual behaviors together to teach a single (more complex, multistep) process
Factors that affect readiness to learn include
what the patient already knows about the disease, the personal meaning of the disease, level of anxiety.
Best Practice refers to making care safe by basing it on
evidence based info
TeamSTEPPS
a strategy of improving patient safety by improving communication.
TCAB
transforming care at the bedside
TCAB- transforming care at the bedside.
climate of safe care
- unit based teams
- client centered care
- eliminating inefficiencies
PEARLS
systems for improving client relationships
partnership empathy apology respect legitimize their feelings
Process for responding to put downs
Address the objection behaviors first
Emphasize specifics
Prepare standard responses
All conflicts have 2 things in common
- Content problem issue
- Process or relationship issue (which is the emotional response to the situation)
The main cause of conflict
lack of communication
Four styles of dealing with conflict
- avoidance
- accommodation
- competition
- collaboration
Avoidance is a
lose-lose for nurse and client
Accommodation is a
lose-win situation. The nurse gives in by making a quick compromise.
Competition is a
direct method of resolving conflict. It can be useful if you need a quick resolution, but in the long term it leads to a lose-lose.
Collaboration
win-win
Assertive behavior
setting goals, acting on those goals, taking responsibility
setting goals, acting on those goals, taking responsibility
Assertive behavior
4 components of assertive behavior
- able to say No
- able to ask for what you want
- express positive and negative feelings
- start, continue, and stop interactions
Dysfunctional conflict occurs when
emotions distort the content of the issue.
Use the acronym CARE to resolve conflicts:
Clarify (clarify the behavior that’s a problem)
Articulate (explain WHY the behavior is a problem)
Request a change
Encourage change
The focus of assertive statements should be on the
present, not the past or future.
describe a competent level of professional behaviors
Professional Performance standards
explains nursing’s role and responsibility to society
Nursing’s social policy statement
legal documents that explain what nurses are allowed to do, their rights, responsibilities, licensure information
Nurse practice acts
legal and ethical boundaries for nurses
Scope of practice
legislated laws from the state and federal level. Example is the Nurse Practice Acts
Statutory laws
laws from court decisions
Civil Laws
malpractice and negligence infractions that are covered by civil law.
Torts
when the case involves intentional misconduct or if it’s a very serious violation
Criminal law
providing ONLY the information needed to provide care for client
Confidentiality
Ethical decision making models
- Utilitarian/goal based model
- Deontologic or duty-based model
- Human Right Model
Whether or not something is ethical is determined by the outcome.
Utilitarian/goal based model
Utilitarian/goal based model
Whether or not something is ethical is determined by the outcome.
This model is person centered. Whether or not something is ethical goes beyond the outcome. In addition to the outcome, you have to consider the person’s dignity. Even if there’s a good outcome, you can’t do something that violates a person’s dignity.
Deontologic or duty-based model
Deontologic or duty-based model
This model is person centered. Whether or not something is ethical goes beyond the outcome. In addition to the outcome, you have to consider the person’s dignity. Even if there’s a good outcome, you can’t do something that violates a person’s dignity.
All people have basic human rights
Human Right Model
feeling of discomfort when there’s a discrepancy between what you have always believed and what you just learned
Cognitive dissonance
when a nurse is not sure which moral rules apply in a given situation
Moral uncertainty
occurs when more than one conflicting morals are involved in the problem
Ethical or moral dilemma
when the nurse knows what is right, but is forced to do something else because it’s the law or the rule
Moral distress
Rightness or wrongness is function of consequences
Greatest good for majority
Utilitarian/goal-based model
Person-centered
Respect person’s inherent dignity
Moral worth
Duty-based model
Universally applied
Shared by most group members
Moral principles
Contemporary framework for Grief
Intersubjective process
“Individual maintains connections with
the absent”
“Meaning of the experience continually
changes”
Intersubjective process
“Individual maintains connections with
the absent”
“Meaning of the experience continually
changes”
Contemporary framework for Grief
signs of Approaching Death
Increased sleeping, somnolence, coma Decreased urinary output Changes in VS Disorientation, restlessness, agitation Severe dyspnea Skin temperature and color
