Unit 1 Exam - Week 2 Flashcards
Organizations that have impacted advancement of nursing practice
- Historically the military and religions have had positive impacts on the advancement of the nursing profession
Army Nursing Service
when and why
- Nursing presence on the battlefield became more common during the Civil War
- the US government established the Army nursing service to organize nurses and hospitals and coordinate supplies for the soldiers
Mildred Montague
what and when
- The associates degree was conceptualized by Mildred Montague during the nursing shortage following World War II
Florence Nightingale
- Founder of modern‐day nursing
- lady with the lamp
- During Crimean War (1800s) established patient care principles.
opened Nightingale home and training school for nurses in 1860, first official nursing program.
wrote “notes on hospitals” 1863
- Air, light, nutrition, adequate ventilation, and space were essential for soldiers to recuperate
- the hospitals she designed Incorporated these ideas which decreased mortality rates length of Hospital stay and the rate of nosocomial infection (HAI)
Clara Barton
- Provided care in tents set up close to the fighting during the civil war
- Continued this Universal care through the establishment of the American Red Cross
Types of nurses
- RN, LVN/LPN, APRN
- Difference in education and scope of practice
- Passed boards = nurse
LVN/LPN Scope of practice
- Diploma program, national exam
- Vitals, med admin, wound care, etc.
- Can collect assessment data but cannot analyze, synthesize, or evaluate data.
- data collection only
- Under direction of licensed physician or registered nurse
- typically in SNF’s, prisons, Dr. Office, school nurse, less in acute care
(LPN – licensed practical nurse everywhere except CA & Texas)
RN Scope of practice
- The RN carries legal responsibility for analysis, synthesis and evaluation of patient data
- determination of whether signs, symptoms exhibit abnormal characteristics
- implementation, based on observed abnormalities
- or the initiation of emergency procedures.
- only the RN can perform assessments, which includes analysis and formulation of a nursing diagnosis
- Evaluates the effectiveness of the care plan
- modifies the plan as needed
BRN Regulation
- Each state enacts its own nurse practice act, CA has BRN
- Defining the practice of professional nursing including scope of practice, approving nursing education programs, establishing criteria that allow a person to be licensed as an APRN, RN or LVN
- Developing rules and regulations to provide guidance to nurses enforcing the rules that govern the education of Nursing and nursing practice
- renew license every 2 years
ANA
long name/function
American Nurses Association (ANA)
* Official professional organization for nurses in the US
* Standards of practice for specialties
* ex: OR, OB, Peds…
RN to patient ratios
where, scale, based on?
Where
- - Acute care only. No SNF’s, non-acute facilities (prisons, mental facilities…)
- higher ratios = bigger team (CNA’s…)
- Postpartum is counted in couplets (mother and baby).
-ex: If the baby is in NICU, the headcount changes
Based on
- patient acuity, of which the mandated ratio is the minimum
- if you have low acuity pt’s on your unit, your ratio goes up.
- ex: having med-surg overflow in a step down unit. Ratio goes up.
Primary nurse model
- used in CA
- allows nurses to plan and coordinate patients’ care over time based on trust relationships
- this care organization is considered essential to avoid fragmentation, improve nursing documentation and achieve person-centered quality
Full Spectrum Nursing
4 points
- Full spectrum nursing is based in science but still focuses on care and nurturing
- clinical judgment
- critical thinking
- problem- solving
- interprofessional collaboration
clinical judgment
- Consists of recognizing and analyzing the cues, prioritizing hypotheses, generating solutions, taking actions, and evaluating outcomes of the client’s condition to determine whether change has occurred
- Involves careful consideration of the client’s condition, medications, and treatment in the evaluation of their health status
Critical thinking
A reflective thinking process that involves
- collecting information
- analyzing the adequacy and accuracy of the information
- carefully considering options for action
problem solving
- a process by which nurses consider an issue an attempt to find a satisfactory solution to achieve the best outcomes
Moving through “Brenner’s Phases of Nursing”
- model assumes that to improve, skill and judgment must be attuned to each clinical situation
- this requires the ability to process information from a variety of sources and to notice subtle variations to guide decision making
National Academy of medicine’s future of Nursing framework
2 categories
IOM Core Competencies and SENC
IOM Core Competencies
5 points
Institute of Medicine
- Provide client-centered care
- work in interprofessional teams
- employ evidence-based practice
- apply quality improvement
- utilize informatics
“SENC”
5 points and model
Safe, Effective nursing Care
(thinking, doing, caring)
6. provide goal-directed, client-centered care
7. collaborate with the interprofessional healthcare team
8. Validate evidence-based research to incorporate into practice
9. provide safe, quality client care
10. embrace/incorporate technological advances
The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity
goal, key areas, nurse infulence
- framework identifying the key areas for strengthening the nursing profession to meet the challenges of the decade ahead.
- These areas include the nursing workforce, leadership, nursing education, nurse well-being, and emergency preparedness and response, as well as responsibilities of nursing with respect to structural and individual determinants of health.
- Nurses play multiple roles in acute care, community, and public health settings, through which they can influence the medical and social factors that drive health outcomes, health equity, and health care equality.
SDOH
Social determinants of health
Benner’s Stages of Nursing
5 phases, and Cuesta application
NACPE: nancy always chooses prickly edamame
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert
- Cuesta takes Brenner’s model and adapts it to fit the 2 year nursing program.
- Rather than going from novice to expert over the course of a career, Cuesta aims for you to go from a novice to proficient student.
Stage 1 of nursing
- novice
- Begins with the onset of Education
- More task based than aware of the big picture
- Novice students perform as close to “textbook” as possible
Stage 2 of nursing
- advanced beginner
- A new graduate usually functions at this level
- begins to focus on more aspects of a clinical situation and applies more facts
- can distinguish abnormal findings but cannot readily understand their significance
- With repeated experiences or mentoring the nurse begins to readily attach meanings to findings
- Advanced beginner students have started to perform skills in a real setting and seek help and guidance to improve
nurse stage that uses facts and recognizes abnormalities
stage 2: advanced beginner
nurse who notices a problem without clinical symptoms and goes by instinct
stage 5: expert
A nurse who is able to identify and achieve objectives
stage 5: expert
care that involves long-term rehabilitation services and care for the dying
tertiary care
nurse who becomes upset when making an incorrect clinical decision is emotionally involved in the clinical choices, while managing care for 4 complex clients
stage 3: competent
the nurse who foresees the client has multiple complex needs and asks for a multiple disciplinary care conference
stage 4: proficient
Stage 3 of nursing
- competence
- nurses achieve competence after 2 to 3 years of nursing practice in the same area
- they have gained additional experience and are able to handle their client load deal with complexity and prioritize situations while providing Compassionate Care
- Competent students start to recognize patterns to help predict the necessary steps to take in a given situation
Stage 4 of nursing
- proficient
- Able to quickly take in all aspects of a situation and immediately give meaning to the cluster of assessment data
- able to see the big picture and can coordinate services and forecast needs
- The proficient student begins to develop holistic thinking and flexibility
Stage 5 of nursing
- Expert
- Able to see what needs to be achieved and how to do it
- they trust their intuition while operating with a deep understanding of a situation often recognizing a problem in the absence of its classic signs and symptoms
If you are considered a resource for other nurses, what stage are you at?
stage 5: expert
Nursing Program mission statement
Educate nursing students to provide safe, ethical, high quality, evidence-based, collaborative, patient-centered nursing care that incorporates clinical judgment and informatics at the entry-level in an increasingly complex healthcare environment.
Goals
1. Students can obtain RN licensure and pursue a career in nursing.
2. Students facilitate optimal health for individual patients, families, and communities.
Government funded health programs
- Government funded programs are paid for with revenue from Federal, state, and local taxes on the citizenry.
- programs include Medicare, Medicaid, children’s, Specialty, and categorical programs
Medicare
- Federal insurance program created by title XVIII (18) of the Social Security Act of 1965
- designed to provide insurance for persons age 65 years and older
- later expanded to include younger people with permanent disabilities, such as end stage renal disease, but provides only limited coverage for long-term care
- financed from a payroll tax levied on employers and employees and from premiums paid by Medicare subscribers
Medicaid
- title XIX (19) of the Social Security Act of 1965
- For individuals with low incomes and minimal resources
- a joint federal and state program, therefore eligibility criteria for Medicaid and the range of medical services offered vary from state to state
- offers a fairly comprehensive set of benefits including prescription drugs skilled care and long-term care
Children’s health insurance program CHIP
- joint federal and state program
- provides health insurance to millions of children whose family has income that exceeds Medicaid eligibility criteria but cannot afford private insurance and who are not covered under a parent’s policy
- Goal is to ensure that children have health insurance and can Access healthcare either through an expansion of Medicaid or the development of a separate program
- we continuation of Chip is not guaranteed because it is based on Federal and State funding that is subject to budgetary allocations
Specialty and categorical programs
categorical programs
- designated by federal laws to provide access to health care for certain categories of people
- ex: immigrants or children in Head Start programs
specialty programs
- Target certain populations
- ex: Indian Health service, military personnel and dependants
Hill‐Burton Act
- It was designed to provide Federal grants to modernize hospitals that had become obsolete due to lack of capital investment throughout the period of the Great Depression and World War II (1929 to 1945)
- Hill-Burton hospitals were required to provide uncompensated services for 20 years after receiving funds
HMO’s vs. PPO’s
HMO plans
- typically have lower monthly premiums. You can also expect to pay less out of pocket.
PPOs
-tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral.
- Out-of-pocket medical costs can also run higher with a PPO plan
Affordable Care Act (ACA)
- Main goal was to increase access to healthcare
- created new healthcare delivery and payment models that emphasize teamwork, care coordination, and Quality Care
- coverage is the creation of accountable care organizations
accountable care organizations
- Groups of Physicians, hospitals, and mental health care providers, who unite to coordinate care for Medicare patients
- the goal is to see that patients, especially the chronically ill, get the right care at the right time, while avoiding duplicate services and preventing errors
- take a leadership role in creating healthcare systems that provide safe quality patient-centered Care
Managed Care
- Designed to control healthcare costs
- a competitive approach to healthcare pricing
- a Managed Care Organization (MCO) contracts with medical providers to provide services at discounted rates or based on a predetermined fixed payment per individual covered under the plan
- employer contracts with the MCO and select the type of healthcare plans for its employees
