Nursing Theory Exam 1 Flashcards
Science and Art of Nursing Practice
● Current knowledge and practice standards
● Insightful and compassionate approach
● Critical reasoning
Benner’s Stages of Nursing Proficiency
● Novice (New Grad nurse)
● Advanced beginner (working as a nurse for about a year, maybe more)
● Competent (when you are able to work independent)
● Proficient
● Expert
Nursing Definitions
● Nursing care is an Art and a Science
● Protection, promotion and optimization of health
● Commonalities
○ Nursing care is holistic
○ Nurses nourish, foster and protect
○ Nurses care for the sick, injured and aging
Nursing Roles
● Autonomy and Accountability
● Caregiver
● Advocate
● Educator
● Communicator
● Manger (Charge nurse, delegate (to nursing aides, LPNs and MAs)
● Military
● Counselor
● Public Health
Facility Based (Nursing roles)
● Direct care, Administration
Community Based
● Public health
● Home health
● Hospice
Military/Government
“Profession” Qualifying Criteria
● Autonomy
● Well-defined body of specific and unique knowledge
● Strong service orientation
● Recognized authority by a professional group
● Code of ethics
● Standards established by professional organization
● Ongoing research
Professional Organizations
● International Council on Nurses (ICN)
● American Nurses Association (ANA)
● National League for Nursing (NLN)
● American Association of Colleges of Nursing (AACN)
● Specialty Nursing Organizations
● National Student Nurse Assn. (NSNA)
Current Trends in Nursing
● Nursing storage
● EBP (Evidence Based Practice)
● Decreased length in stay
● Aging population (baby boomers)
● Chronic health conditions
● Culturally competent care
● Complementary therapies (herbal healing)
● Community-based nursing
Influences on Nursing
● Money
● Nursing shortage
● Insurance (medicare)
QSEN Competencies
- Patient centered care
- Teamwork and collaboration
- Quality and safety
- Professionalism
- Evidence based practice (EBP)
- Informatics (technology)
a. These are the qualities that student nurses need to learn so they can practice safely.
Critical Thinking and Clinical Judgment
● What is the difference?
○ Def: Broad term used in nursing that includes reasoning about clinical issues such as teamwork, collaboration, streamlining assignments, etc.
○ Def: “A complex cognitive process that uses formal and informal thinking stratifies together and analyzes patient information, evaluates the significance of the data and weighs alternative actions to take.
Levels of Critical Thinking
● Basic- counts on experts to know the right answers
● Complex- Begin to separate themselves from the experts
● Commitment- Anticipate when to make choices without assistance
Qualities of a “Critical Thinker”
● Independence of thought
● Fair-mindedness- consider all avenues without bias
● Insight into the “greater good”
● Intellectual humility- recognize own limitations
● Non Judgemental- using professional standards not personal values
● Integrity- being honest
● Perseverance- persisting despite difficulty
● Confidence- believing in self to complete task
● Curiosity- asking “why” and wanting to know more
Inductive/Deductive Reasoning and Clinical Judgment
● Inductive Reasoning- involves noticing cues, making generalizations and creating
hypotheses.
○ Cues are data that falls outside the expected finding, that give the nurse a hint or
indication of a patient’s potential and actual problem
○ Generalization a judgment formed from a set of facts, observations (we often
think of these data points as part of what the nurse assess)
○ Hypothesis is a proposed explanation for a situation- it attempts to explain the
“why” behind the problem that is occurring.
The Nursing Process
● Def: A systematic, client-centered, critical thinking, goal-oriented model of delivering care
● Benefits
○ Continuity
○ Collaboration
○ Enhanced client outcomes
○ Patient-centered care
● Purpose if the nursing process
○ Organizes data
○ Formal statement of strategies
○ Efficient
○ Aids in the Delivery of care that is:
■ Holistic
■ Goal oriented ■ Individualized
Steps of the Nursing Process
○ Assessment
○ Diagnosis (outcomes identification)
○ Planning
○ Implementation
○ Evaluation
The CJMM (clinical judgment model)
- Recognize cues
- Analyze cues
- Prioritize hypothesis
- Generate solutions
- Take action
- Evaluate outcomes
Nursing Assessment
● Overall purpose
○ Determine immediate needs and priorities
○ Identify strengths for solving problems
○ Focus on a specific problem
○ Identify risk for complications
○ Recognize complications
○ Establish a database
Nursing Assessment
● Subjective Data (symptoms)
○ What the patient/family tells you
○ Uses patient’s own words, “I feel dizzy”
Nursing Assessment
Objective (signs)
○ Observable and measurable
○ Verifiable by another person
○ Specific and non-judgmental (avoid terms like normal, good, aderage, small,
large)
○ Example: vomited 150 cc of undigested food 1⁄2 hour after breakfast
Nursing Assessment
● Data
○ Purposeful characteristics
○ Complete as possible
○ Factual and accurate
○ Relevant
Nursing Assessment
● Sources of assessment data
○ Interviewing
■ Includes patient and possibly family members
○ Physical Examination (physical assessment)
○ Reviewing lab, diagnostic data
○ Part of assessment is also gathering from colleagues, provider notes and orders,
shift reports.
Types of assessments
Primary survey
Admission assessment
Ongoing assessment
Focused assessment
Time lapsed assessments
Primary survey
Used in every patient to briefly evaluate LOC (AxO), airway, breathing and circulation and respond to emergent situations as needed.
Admission assessment
Sometimes called comprehensive assessment, involves assessing a large amount of data using an organized approach.
Ongoing assessment
Regular assessments, monitoring for changes at least once each shift or more depending on patient condition (physical assessment)
Focused assessment
Focused assessment allow for re-evaluation of the status of a previously identified problem, or focus on one body system based upon assessment data
Time lapsed assessments
Periodic assessment over longer periods 3 or more months, ex- LTC.
Examples; patient with CHF, check edema, labs, etc every 3 months
Assessment
● First step in the nursing process
○ Ask yourself…
■ What is the patient’s primary problem and what is the underlying cause or
pathophysiology?
■ Look at the admission dx or medical problem-read until you understand
the pathi of the disease.
■ Treat this as a puzzle that you need to solve in order to provide good
○ What
■ s/s
care.
clinical data is relevant?
■ Look at patient cues
■ What nursing priority captures the “essence” of your patient’s current
status and will guide your plan for care
1. Identify the appropriate dx
2. Identify related factors
3. List the defining characteristics (s/s)
Definition: Nursing Diagnosis
● Clinical judgment
● Individual, family, or community
● Response to actual or potential health problems or life process
● Basis for outcomes and interventions
● The nurse is accountable
Planning Nursing Interventions (Three types)
- Independent Nursing Interventions
a. Any intervention that does not require a prescription (MD Order) i. Examples: teaching/education - Dependent Nursing Interventions
a. Require a prescription- Prescriptions are orders, interventions, remedies, or
treatments ordered or directed by an authorized primary healthcare provider. i. Example: PRN, medications, therapy. - Collaborative Nursing Interventions
a. Actions that the nurse carries out in collaboration with other health team
members- MD, Social work, d/c planner, PT, Resp tx and pharm.
i. Example: homeless patient, work with social worker or d/c planner to help
with resources, INS, etc.
Nursing Diagnosis: Critical Thinking
● Analyze information
● Nursing Diagnosis: Definitions and Classification 2012-2014
● Approved nursing diagnoses
○ Does it fit the definition provided by the North American Nursing Diagnosis Association- International (NANDA-I)
○ Are the defining characteristics in the assessment?
○ Can a change occur with a nursing intervention?
Use of Assessment Information
● Organize the information
○ Identify patterns in the assessment
○ Highlight or underline possible problems
■ Make a list of all the problems and potential problems
○ Group together problems that are similar
○ Make initial inference or impressions
○ Prioritize the problems
■ Maslow’s hierarchy
■ Safety
■ Start with unstable client problems
○ Record and report the information
Analyzing Cues
- What cues are most concerning?
- What does this clinical data mean?
- What is the TREND of relevant clinical data?
- What findings fit together?
- What additional clinical data is needed to identify the current problems?
What best describes the limits of the diagnosis?
Examples: anticipatory, compromised, decreased, delict, impaired, increased, ineffective
readiness.
NANDA Diagnosis
● Does the selected diagnosis fit the NANDA definitions?
● Is this diagnosis consistent with what the patient is demonstrating?
● Does the patient agree that this is what is a concern?
● Is it an actual risk or a wellness diagnosis?
Nursing Diagnostic Statement
● A working nursing diagnosis may have two or three parts.
● The two-part system consist of the nursing diagnosis and the “related to” statement
● The three-part system consists of the nursing diagnosis, the “related to” statement, and
the defining characteristics.
○ The three-part diagnostic statement may be referred to as the PES system
■ (P) problem: nursing diagnosis label
■ (E) etiology: “related” to phase
■ (S) symptoms: defining characteristics
Hot Ethical Issues
Organ Donation, Surrogate motherhood, Abortion, Euthanasia, Advance Directives
Ethics
Ethics-Beliefs and values influence decisions, goals and actions
Basic Principles of Ethics
Advocacy, Responsibility, Accountability , Confidentiality
Values (DEF)
● Def: A personal belief about the worth of something that acts as a standard guide one’s
behavior.
● Ideas or concepts that give meaning to an individual’s life.
Development of Values
● Modeling
● Moralizing
● Laissez-faire
● Reward and punishment
● Responsible choice
Professional Values
● Altruism
● Autonomy
● Human Dignity
● Integrity
● Social Justice
Ethics and Morals
● A systematic inquiry into principles of right and wrong, of virtue and vice, and of good
and evil as they relate to conduct.
● Morals-are personal or group standards of right and wrong
Types of Ethics
● Bioethics
○ Research conducted
○ Genetic enhancement
○ Environmental ethics
○ Sustainable healthcare
● Clinical Ethics (bedside)
● Nursing Ethics (practice)
Ethical Decision Making Process
● Assess the situation, people, variables
● Diagnose the ethical problem (dilemma)
● Plan on a course of action
● Implement (can you?)
● Evaluate your decision
Ethical Dilemma
● Nurses point of view
● Care from many different providers
Nurses Code of Ethics
● Framework for making ethical decisions
● Defines moral norms for professional nursing conduct
○ ICN Code of Nurses
○ ANA Code for Nurse
○ ANA Practice Standards
Professional Regulation of Nursing
● American Nurses Association (National)
● State Nurses Associations
○ Arizona Nurses Association
● Specialty, neurology, pediatrics, infusion, gerontology, endocrinology, school nursing,
educators, nurse practitioners, anesthesiology, etc.
Federal Laws
● PPACA
● ADA
● EMTALA
● PSDA
● NOTA
● HIPAA
● HITECH
Health Insurance Portability and Accountability Act (HIPAA)
● Passed by Congress in 1996
● Applies to personally identifiable information (electronic, paper and oral)
● Defines regulations regarding protection of patient privacy
● Outlines practices designed to enforce regulations
● Deines punishment for violations
Nursing and HIPAA
● Client Privacy Rules
● Protecting Client Privacy
○ Clients Medical Record
○ Clients Environment
○ Transmitting Records
State Laws Affecting Healthcare
● Informed Consent and Healthcare
● Good Samaritan Laws
● Public Health Laws
● Uniform Determinations of Death Laws
Purpose of Professional Regulation
● Voluntary membership
● Standards of Care (Practice Standards)
● Certification
● Lobbying
● Political endorsements
● Disseminations of information
● Consulting
Local Laws Affecting Nursing
● Local fire codes, police regulations and county health department regulations
● Facility policy and procedures
● County Public Health Laws
Multi-State Licensure
● National Council for State Boards of Nursing
○ Nurse Licensure Compact (NLC)
○ Participating states
Good Samaritan Laws
● Protect healthcare providers who give aid in an emergency (while off duty)
● Provider is not obligated to give care BUT care that is started cannot be abandoned
● Care must be within provider’s scope of practice
● Care must not be grossly negligent
Clients Rights
● The Patient’s Bill of Rights (renamed “The Patient Care Partnership”)
● Last revised by American Hospital Association in 2003
● Addresses expectations, rights and responsibilities of hospitalized clients
● Confidentiality
● Notice of Privacy Practices
Nursing Workforce Issues
● Student Nurses
● Staffing
● Nurse to patient ratios
● Nursing Assignments
● Nurse Delegation
5 Rights of Delegation
- Right Task
- RIght Circumstance
- RIght Person
- Right Direction and Communication
- Right Supervision and Evaluation
Crimes
Felonies or misdemeanors
Punishable by the state
Torts
Wrong acts committed by a person against another person or their property
Intentional or unintentional
Subject to action in a civil court
Intentional Torts
● Assault
● Battery
● Defamation of character
● Invasion of privacy
● False Imprisonment
● Fraud
Unintentional Torts
● Negligence
● Malpractice
○ Direct action or lack of action
○ Improper or unethical conduct
○ Unreasonable lack of skill
○ Elements of liability
-Duty, Breach of Duty Foreseeability any harm, Causation, Damages
Major Categories of Malpractice
● Failure to follow standards of care
● Failure to use equipment in a responsible manner
● Failure to communicate
● Failure to document
● Failure to assess and monitor
● Failure to act a patient advocate
Factors Contributing to Increase in Nursing Malpractice
● Delegation
● Early discharge
● Nursing shortage
● Advances in Technology
● Increased Autonomy and Responsibility
● Better informed consumers
Avoiding Torts
● Adhere to your scope of practice and professional practice standards
● Be accountable
● Keep current
● Respect client rights
● Careful documentation
● Develop client trust
● Identify potential suits
Types of Consents
● Admission consent
● Operative consent
● Special invasive procedures
● Blood transfusions
● HIV Testing
● Sterilization consent
Advance Directives
● Living will- healthcare wishes are legally documented by patient in advance
● Durable Power of Attorney
● Durable Power of Attorney for Healthcare (Medical Power of Attorney MPOA)
● DNR- Do Not Resuscitate
