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)
