Nursing Intro - Exam 3 Flashcards
what is theory?
the foundation for the art and science of nursing
theory, research, and practice are bound together in a continuous …
interactive relationship
what is nursing theory?
a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models
what is a phenomenon?
the terms you use to describe something
domain
- perspective of a profession
- provides practical and theoretical aspects of discipline
nursing paradigm
- person
- health
- environment/situation
- nursing
types of theory
- grand theories
- middle range theories
- practice theories
- goes from most abstract to least abstract
shared theories
- explain a phenomenon specific to the discipline that developed the theory
- also known as a borrowed or interdisciplinary theory
Ex - maslows hierarchy of needs
*piaget’s theory of cognitive development
*erikson’s theory of psychological development
maslow’s hierarchy of needs
- self actualization
- esteem
- love/belonging
- safety
- physiological
psychosocial theories
- needed in nursing to meet needs of pt’s
- physiological needs
- psychological needs
- sociocultural needs
- developmental needs
- spiritual needs
what is nightingales environmental theory?
environment as the focus of nursing care
what is peplau’s interpersonal theory?
focus on interpersonal relations between nurse, pt, and pt’s family
what is hendersons need theory?
- 14 basic needs of the whole person
- nursing care based off of needs of the individual
what is orems self-care deficit nursing theory?
- focuses on pt’s self care needs
- goal is for pt’s to manage his/her own health problems
what is leiningers culture care theory?
- theory of culture care diversity and universality
- integrates pt’s cultural traditions, values, and beliefs into care plans
what is benner and wrubels theory?
caring is central to nursing
relationship between nursing theory and nursing research
- theories provide direction for nursing research
- nursing theory and nursing research build the knowledge base for nursing, which is then applied to practice
- theory-generating or theory-testing research refines the knowledge base of nursing
- nurses incorporate research-based interventions into theory-based practice
standards for pt education
- all state nurse practice acts recognize that pt teaching falls within the scope of nursing practice
- JCO sets standards for pt and family education
- successful accomplishment of standards requires collaboration among health care professionals
purposes of pt education
- to help individuals, family, or communities achieve optimal levels of health
pt education includes
- maintenance and promotion of health and illness prevention
- restoration of health
- coping with impaired functioning
teaching
the concept of imparting knowledge through a series of directed activities
learning
the purposeful acquisition of new knowledge, attitudes, behaviors, and skills through an experience or external stimulus
role of the nurse in teaching and learning
- teach information that pt’s and families need to make informed decisions regarding their care
- determine what pt’s need to know
- identify when pt’s are ready to learn
TJC’s speak up tips
- Speak up if you have questions or concerns
- Pay attentions to the care you get
- Educate yourself about your illness
- Ask a trusted family member or friend to be your advocate
- Know which meds you take and why
- Use a health care organization that has been carefully evaluated
- Participate in all decisions about your treatment
teaching as communication
- closely parallels the communication process
- depends partly on effective interpersonal communication
- the learning objective describes what the learner will be able to accomplish after instruction is given
- effective communication involves feedback
domains of learning;
cognitive
includes all intellectual behaviors and requires thinking
domains of learning;
affective
deals with expression of feelings and development of attitudes, opinions, or values
domains of learning;
psychomotor
involves acquiring skills that require coordination and integration of mental and physical movements
domains of learning;
kinesthetic
involves hands on learning
basic learning principles
motivation to learn
addresses the pt’s desire or willingness to learn
basic learning principles
ability to learn
depends on physical and cognitive abilities, developmental level, physical wellness, though processes
basic learning principles
learning environment
allows a person to attend to instruction
attentional set
the mental state that allows the learner to focus on and comprehend a learning activity
motivation
force that acts on or within a person to cause the person to behave in a particular way
use of theory to enhance motivation and learning
- theories focus on how individuals learn
- help guide instructional strategies
psychosocial adaptation to illness
grieving
active participation
implies an eagerness to acquire knowledge or skills
developmental capability
- cognitive development
- prior knowledge
learning in children
developmental stage
adult learning
- self directed
- pt centered
physical capability
- level of personal development
- physical health
- energy
learning environment
- well lit
- good ventilation
- appropriate furniture
- comfortable temperature
- quiet
- private
nursing process: assessment
- see through the pt’s eyes
- assess the pt’s learning needs
- motivation to learn
- ability to learn
- teaching environment
- resources for learning
health literacy
the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promotes and maintain good health
health literacy includes …
- pt’s reading ability
- pt’s mathematics skills
- pt’s comprehension
- pt’s decision making and functioning skills
nursing diagnoses for pt education
- deficient knowledge
- ineffective health maintenance
- impaired home maintenance
- ineffective family therapeutic regimen management
- ineffective self- health management
- noncompliance
planning
determine goals and outcomes that guide the choice of teaching strategies and approaches with a pt
- set priorities
- select timing to teach
- organize the teaching material
- use teamwork and collaboration
implementation
- maintain learning attention and participation
- build on existing knowledge
- select teaching approach
- incorporate teaching with nursing care
- illiteracy and other disabilites
- cultural diversity
- using different teaching tools
- special needs of children and older adults
select appropriate instructional methods
- group
- one on one
- preparatory
- demonstration
- analogy
- role playing
- simulation
evaluation
- see through the pt’s eyes
- have their learning needs been met?
- pt outcomes
- legal responsibility
- documentation
- teach back
social
acknowledge a learned behavior
activity
person is motivated to engage in an activity and learn if they have the opportunity to engage in a more desirable activity after the task has been completed
material
person is motivated to learn due to receiving tangible rewards afterwards
types of loss
- necessary loss
- maturational loss
- situational loss
- actual loss
- perceived loss
a normal but bewildering cluster of ordinary human emotions arising in response to a significant loss, intensified and complicated by the relationship to the person or the object lost
grief
types of grief
- normal/uncomplicated
- anticipatory
- disenfranchised
complicated grief
- chronic
- exaggerated
- delayed
- masked
stages of dying (kubler ross)
- denial
- anger
- bargaining
- depression
- acceptance
attachment theory (bowlby)
- numbing
- yearning and searching
- disorganization and despair
- reorganization
factors influencing loss and grief
- human development
- personal relationships
- nature of the loss
- coping strategies
- socioeconomic status
- culture
- spiritual and religious beliefs
handling grief
- through the pt’s eyes (be present, active listening, therapeutic touch, be open, ask honest questions)
- grief variables
- grief reactions
health promotion
- focus on coping and optimizing health
- palliative care
- hospice care
- DNR
- DNI
- use of therapeutic communication
- provide psychosocial care
- management of symptoms
- promote dignity and self esteem
- maintain a comfortable and peaceful environment
- promote spiritual comfort and hope
- protect against abandonment and isolation
- support the grieving family
- assist with end-of-life decision making
- facilitate mourning
hospice care
- a philosophy and model for the care of terminally ill pt’s and their families at the end of life
- usually have less than 6 months to live
- manage pain, provide comfort, ensure quality of life
- adheres to pt wishes
physical changes in hours or days before death
- increased periods of sleeping
- coolness and color changes in extremities, nose, fingers
- bowel or bladder incontinence
- decreased urine output
- restlessness, confusion
- decreased intake of food or fluids
- congestion/increased pulmonary secretions
- altered breathing
- decreased muscle tone, relaxed jaw muscles
- weakness and fatigue
care after death
- organ and tissue donation
- autopsy
- continues support of family members
- respectful of body
- postmortem care
- allow family to visit with deceased
nurses and grieving
- understand your own feelings about grief and death
- after death of a pt, talk with another colleague or write down your thoughts
- give yourself time to mourn, grieve, cry
the components of the nursing metaparadigm include?
- person, health, environment, and theory
- health, theory, concepts, and environment
- nurses, physicians, health, and pt needs
- person, health, environment, and nursing
theory is essential to nursing practuce because it (select all that apply)
- contributes to nursing knowledge
- predicts pt behaviors in situations
- provides a means of assessing pt vital signs
- guides nursing practice
- formulates health care legislation
- explains a relationship between concepts
a nurse ensures that each pt’s room is clean; well ventilated; and free from clutter, excessive noise, and extremes in temperature. which theorists work is the nurse practicing in this example?
- Henderson
- Orem
- King
- Nightingale
the nurse is caring for a pt admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. the nurse assumes responsibility for bathing and feeding the pt until the pt can begin performing these activities. the nurse in this situation is applying the theory developed by:
- Johnson
- Orem
- Roy
- Peplau
math the following types of theory with the appropriate description
- middle rang theory
- shared theory
- grand theory
- practice theory
a. very abstract; attempts to describe nursing in a global context
b. specific to a particular situation; brings theory to the bedside
c. applies theory from other disciplines to nursing practice
d. addresses a specific phenomenon and reflects practice
match the following descriptions to the appropriate grand theorist
- King
- Henderson
- Orem
- Neuman
a. based on the theory that focuses on wellness and prevention of disease
b. based on the belief that people who participate in self care activities are more likely to improve their health outcomes
c. based on 14 activities, the belief that the nurse should assist pt’s with meeting needs until they are able to do so independently
d. based on the belief that nurses should work with pt’s to develop goals for care
which of the following statements related to theory based nursing practice are correct? (select all that apply)
- nursing theory differentiates nursing from other disciplines
- nursing theories are standardized and do not change over time
- integrating theory into practice promotes coordinated care delivery
- nursing knowledge is generated by theory
- the theory of nursing process is used in planning pt care
- evidence based practice results from theory testing research
a nurse is caring for a pt who recently lost a leg in a motor vehicle accident. the nurse best assists the pt to cope with this situation by applying which of the following theories?
- Roy
- Watson
- Johnson
- Benner
using maslows hierarchy of needs, identify the priority for a pt who is experiencing chest pain and difficulty breathing
- self actualization
- air, water, and nutrition
- safety
- esteem and self esteem needs
which of the following categories of shared theories would be most appropriate for a pt who is grieving the loss of a spouse?
- biomedical
- leadership
- psychosocial
- developmental
a pt asks a nurse to provide instruction on how to perform a breast self exam. which domains are required to learn this skill? (select all that apply)
- affective domain
- sensory domain
- cognitive domain
- attentional domain
- psychomotor domain
a pt suddenly experiences a severe headache with numbness and decreased movement in the left arm. the emergency room physician suspects a stroke and is going to have the pt undergo an emergent angiogram to remove the clot. which teaching approach is most appropriate?
- selling approach
- telling approach
- entrusting approach
- participating approach
a nurse is caring for a young pt who has been told he has multiple sclerosis. the nurse has planned time to conduct a teaching session that will focus on the disease and principles of management. the nurse chooses to use the EDUCATE model to proceed with instruction. which of the following are components of the model? (select all that apply)
- state goals of the sessions for the pt
- repeat the most important information
- practice empathetic skills
- be aware of nonverbal messages
- use a standard question list for the chosen topic
a nurse is teaching an older adult pt about ways to detect a melanoma. which of the following are age appropriate teaching techniques for the pt (select all that apply)
- speak in a low tone
- begin and end the session with the most important information regarding melanoma
- provide a pamphlet about melanoma with large font in blues and greens
- provide specific information in frequent, small amounts for older adult pt
- speak quickly so that you do not take up much of the pt’s time
a 55 year old adult male has been in the hospital over a week following surgical complications. the pat has had limited activity but is now finally ordered to begin a mobility program. the pt just returned from several diagnostic tests and tells the nurse he is feelings quite fatigued. the nurse prepares to instruct the pt on the mobility program protocol. which of the following learning principles will likely be affected by this pt’s condition?
- motivation to learn
- developmental stage
- stage of grief
- readiness to learn
a pt recovering from open heart surgery is taught how to cough and deep breath using a pillow to support or splint the chest incision. following the teaching session, which of the following is the best way for the nurse to evaluate whether learning has taken place?
- verbalization of steps to use in splinting
- selecting from a series of flash cards the images showing the correct technique
- return demonstration
- cloze test
a pt’s cultural background affects the motivation for learning. using the ACCESS model, match the nursing approach with the correct model component
- assessment
- communication
- cultural
- establishment
- sensitivity
- safety
a. help pt feel culturally secure and able to maintain their cultural identity
b. remain aware of verbal and nonverbal responses
c. be aware of how pts from diverse backgrounds perceive their care needs
d. become aware of your pt’s culture and your own cultural biases
e. learn about the pt’s health beliefs and practices
f. show respect by creating a caring rapport
a 63 year old woman is a family caregiver for her 88 year old mother who has dementia. the caregiver asked the home health nurse how to manage her mother when she becomes confused and violent. the best instructional method a nurse can use for this situation is
- demonstration
- preparatory instruction
- role playing
- group instruction with other family caregivers
a nurse is preparing to teach a pt who has sleep apnea how to use a CPAP machine at night. which action is most appropriate for the nurse to perform first?
- allow pt to manipulate machine and look at parts
- provide a teach back session
- set mutual goals for the education session
- discuss the purpose of the machine and how it works
which of the following scenarios demonstrates that learning has taken place (select all that apply)
- a pt listens to a nurses review of the warning signs of a stroke
- a pt describes how to set up a pill organizer for newly ordered medications
- a pt attends a spinal cord injury support group
- a pt demonstrates how to take a blood pressure at home
- a pt reviews written information about resources for cancer survivors
to best assist a pt in the grieving process, which factors are most important for the nurse to assess? (select all that apply)
- previous experiences with grief and loss
- religious affiliation and denomination
- ethnic background and cultural practices
- current financial status
- current medications
which interventions does a nurse implement to help a pt at the end of life maintain autonomy while in a hospital? (select all that apply)
- use therapeutic techniques when communicating with the pt
- allow the pt to determine timing and scheduling of interventions
- allow pt’s to have visitors at any time
- provide the pt with a private room close to the nurses station
- encourage the pt to eat whenever he or she is hungry
the nurse recognizes that which factors influence a persons approach to death? (select all that apply)
- culture
- spirituality
- personal belief
- previous experiences with death
- gender
- level of education
a nurse has the responsibility of managing a pt’s postmortem care. what is the proper order for postmortem care when there is no autopsy ordered?
- bathe the body of the deceased
- collect any needed specimens
- remove all tubes and indwelling lines
- position the body for family viewing
- speak to the family members about their possible participation
- ensure that the request for organ/tissue donation and/or autopsy was completed
- notify support person for the family
- accurately tag the body, including the identity of the deceased
- elevate the head of the bed
which comments to a pt by a new nurse regarding palliative care needs are correct? (select all that apply)
- “even though your continuing treatment, palliative care is something we might want to talk about”
- “palliative care is appropriate for people with any diagnosis”
- “only people who are dying can receive palliative care”
- “children are able to receive palliative care”
- “palliative care is only for people with uncontrolled pain”
a pt is receiving palliative care for symptom management related to anxiety and pain. a family member asks whether the patient is dying and now in “hospice”. what does the nurse tell the family member about palliative care? (select all that apply)
- palliative care and hospice are the same thing
- palliative care is for any pt, any time, any disease, in any setting
- palliative care strategies are primarily designed to treat the pt’s illness
- palliative care relieves the symptoms of illness and treatment
- palliative care selects home health care services
when planning care for a dying pt, which interventions promote the pt’s dignity? (select all that apply)
- providing respect
- viewing the pt as a whole
- providing symptom management
- showing interest
- being present
- inserting a straight catheter when the pt has difficulty voiding
what are the physical circulatory changes that occur as death approaches?
- skin irritation
- mottling
- increased urine output
- weakness
when providing postmortem care, which actions are necessary for the nurse to complete?
- locating the pt’s clothing
- calling the funeral home
- providing culturally and religiously sensitive care in body preparation
- providing postmortem care to protect the family of the deceased from having to view the body
which actions by the nurse help grieving families? (select all that apply)
- encourage involvement in nonthreatening group social activities
- follow up with the family in their home
- remind them that feelings of sadness or pain can return around anniversaries
- encourage survivors to ask for help
- look for overuse of alcohol, sleeping aids, or street drugs
