Shared Flashcard Set

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N260
test 2
324
Nursing
Undergraduate 1
11/15/2010

Additional Nursing Flashcards

 


 

Cards

Term
Morals
Definition

 

Established rules of conduct
Term

 

Values
Definition

 

Attitudes, ideals or beliefs to guide behavior
Term

 

Ethics
Definition

 

Identify what should be done to live with one another.
Term

 

Code of Ethics
Definition

 

  • l
  • l
  • l
  • Provides a framework of decision making for the profession
    Written list of a profession’s standards of conduct
An implied contract through which a group informs society of the rules and principles of how they will function
Term

 

Why is Ethics important to Nursing?
Definition

 

¡Nurses face ethical dilemmas everyday
lNurses offer a holistic perspective of human beings and their health needs in health care and other organizations. Respect for persons, avoiding harm, providing benefits of nursing care for all in need, and promotion of justice in health care are foundational obligations in the practice of nursing as found in the ANA Code of Ethics (Aroskar)
Term

 

ANA Code for Nurses
Definition

¡First adopted in 1950

Emphasized a broad spectrum role of the RN

¡
Revised 1960

l

Emphasized professionalism and upholding standards of a profession

¡

Revised 1976
lThe word “Client” was adopted to be all inclusive of the patient population
¡Revised 1985
lEmphasis was placed on Client’s rights
Term

 

ANA Code of Ethics for Nurses (2001)
Definition

 

lProvisions 1-3 Fundamental Values and Commitments of the Nurse
lProvisions 4-6 Boundaries of Duty and Loyalty 
lProvisions 7-9 Duties to the Broader Community 
Term

 

International Council of Nurses
Definition

 

¡Code of Ethics
lNursing’s respect for the life, dignity, and integrity of all people in a manner that is unmindful of nationality, race, creed, color, age, sex, political affiliation, or social status
Term

 

Utilitarianism
Definition

 

Asserts that it is right to maximize that greatest good for the happiness of the greatest number of people
The end justifies the mean
Term

 

Deontology
Definition

 

The rightness or wrongness of an action depends of the moral significance of the action
It is not the result of the act that make it right or wrong, but the principles upon which the act is carried out
Term

 

Virtue Ethics
Definition

¡Individuals’ actions are built from a degree of inborn moral virtue
¡Character traits – Honesty, courage, kindness, respectfulness, and integrity
¡From one’s way of being flows a way of acting in both one’s personal and professional life.
¡Nurses way of being and acting are essential to the integrity of nursing practice and  patient care
Term

 

Ethical Theories
Definition

 

Utilitarianism
 
Deontology
Term

 

Ethical Principles
Definition

 

¡Respect
The most fundamental right of every person
Valuing every aspect of a person’s life
Foundation of all ethical principles
 
¡Justice
¡Autonomy
¡Beneficence
¡Non maleficence
¡Veracity
Term

 

Justice
Definition

 

¡Equals should be treated the same
¡Unequals should be treated differently
What does this mean?
Obligation to be fair to all people regardless of race, gender, marital status, medical diagnoses, social standings, economic level, etc.
Term

 

Autonomy
Definition

 

¡Individuals have the right to determine their own actions
¡Freedom to make one’s own decisions
¡Patient Self Determination Act  (1991)
lAdvance Directives – legal documents that indicate wishes of individuals in regard to end of life issues.
Term

 

Beneficence
Definition

 

¡The “Doing of Good
¡Avoidance of harm
¡Promote good
¡Encompasses nonmaleficence
lTO DO NO HARM
Term

 

Nonmaleficence
Definition

 

¡The duty to do NO harm
¡Nurses must not act knowingly in a manner that would intentionally harm a client
¡Foundation for the Hippocratic Oath
¡Protect those from harm that can not protect themselves
Term

 

Veracity
Definition

 

¡Tell the Truth
¡Necessity to the development and continuance of trust among human beings
¡Do not intentionally deceive or mislead clients
Term

 

Fidelity
Definition

 

Nurse-patient relationship
FAITHFUL
Term

 

Moral Development
Definition

 Kohlberg-Justice- studied men and boys' moral reasoning as a function of cognitive development and found 1. preconventional 2. conventional 3. postconventional stages of moral development/reasoning

 
Gilligan-Care- she believed kohlberg's study focused only on men and found that girls relational orientation to the world shaped their moral reasoning differntly than that of men and boys
Term

 

Most causal factors of
Ethical Dilemmas
Definition

 

¡Personal Value System
¡Peers’ and other Professionals’ Behavior
¡Patient’s Rights
¡Institutional and Societal Issues
Term

 

Ethical Decision Making Model
Definition

 

¡Clarify the Ethical Dilemma
¡Gather additional data
¡Identify Options
¡Make a decision
¡Act
¡Evaluate
Term

 

Nursing Process
Definition

 

¡Assess
¡Analyze
¡Plan
¡Implement
¡Evaluate
Term

 

Model Nurse Practice Act
Definition

 

¡Defines nursing practice and establishes standards for nurses in each state
¡Sets the educational qualifications and requirements for licensure
¡Determines the legal titles and abbreviations nurses may use
¡Provides for disciplinary action of licensees for certain causes
Term

 

State Board of Nursing
Definition

 

¡State Legislation creates the Nurse Practice Act and grants authority to the State Board to administer the Act
¡Enforce the Nurse Practice Act and provide disciplinary action
¡Provide licensing examination
¡Licensure of Nurses including by endorsement 
Term

 

 
Malpractice
Definition

 

Negligence that occurs when expected standards of care are not met by professionals (Unintentional Tort)
Term

 

Torts
Definition

 

Civil wrongs against a person and may be intentional or unintentional
Term

 

Negligence
Definition

 

lThe failure to act as a reasonably prudent person would have in specific circumstances
Term

 

Duty of Care
Definition

 

lResponsibility of the nurse for the care of the patient
Term

 

Breach of Duty
Definition

 

lFailure to perform duty of care according to accepted standards
Term

 

Damage or Harm
Definition

 

lInjury to the patient in physical, psychological, or financial sphere
Term

 

Proximate Cause
Definition

 

lAction occurring immediately before an injury occurred, thereby assumed to be the reason for the injury
Term

 

Delegation
Definition

 

¡Nurses must delegate tasks and responsibilities to the appropriate person and must follow up to ensure that the task was completed and done properly
¡Empowering one to act for another
¡Nurse holds accountability and responsibility for the task delegated
Term

 

5 Delegation Rights
Definition
  1. Task
  2. ¡Circumstances
  3. ¡Person
  4. ¡Direction/communication
  5. ¡Supervision/evaluation
¡
Term

 

Assault and Battery
Definition

 

¡Nonconsented touching or the threat of nonconsented touching is present unless informed consent is given or implied by the patient.
¡Assault and Battery occur when medical exam or treatment occur without the patient’s consent
¡Consent may be withdrawn at any time
Term
Informed Consent
Definition
Consent must be given voluntarily
Free from coercion
Client must be of competent capacity
Mental status of Client
Client must have appropriate and adequate information to make a decision
Risks/benefits, side effects, costs, alternatives
Term

 

Nurse’s Responsibility
Definition

 

¡Not to explain, but to witness
¡Elements of valid consent are in place
lCommunicating patient’s need for more information
lProviding feedback, if patient wants to change consent
Term
Confidentiality
Definition
Protection of private information gathered about a client during the provision of healthcare services
Nurses must assure the privacy of the client is maintained
HIPPA
Term

 

Exceptions to Privacy
Definition

 

¡Discussing care with others involved in direct care of client
lPhysicians, PT/OT, case coordinator
¡ Quality assurance activities
lFall risks, Needle sticks
¡Law demands disclosure
lSafety of another is at risk
Term

 

Duty to Report
Definition

 

¡Child Abuse
¡Elderly Abuse
¡Gunshot Wounds
¡Communicable Diseases
¡Threats toward third parties
Term

 

Preventing Legal Issues
Definition

 

¡Practice in safe setting
l
Adequate staffing
¡Communicate with other professionals
lDocumentation !!!!!!! it never happened if it is not documented
¡
¡Meet Standards of Care
lBe a prudent, knowledgeable practitioner
¡Professional Liability Insurance
lPersonal liability insurance is broader than employer sponsored plans
¡Positive relationships with clients (the disgruntled client is often the one that sues)
lProvide individualized, concerned care
Delegate wisely  
Policies and procedures
Term

 

Four Documents to Have
Definition

 

¡Nurse Practice Act
¡Nursing’s Social Policy Statement
¡Nursing: Scope and Standards of Practice (and your specialty standards)
¡ANA Code of Ethics with Interpretive Statements
Term

 

Policy
Definition

 

the principles and values that govern action toward given ends.  Policy sets forth a plan, a direction, a goal for action.
Term

 

Politics
Definition

 

¡deals with the regulation and control of people living in society; in government the allocation of scarce resources.
Term

 

Power
Definition

 

¡Position
¡Knowledge/information
¡Power of numbers
¡Power of wealth
¡Power of dominance
¡Latent power
¡Expert power
¡Legitimate power
Term

 

Nurse Involvement
Definition

 

¡Nurse citizen-performs fundamental civic responsibilities, brings the perspective of healthcare to the voting booth, forums and community activities
¡Nurse activist-takes a moral active role in the policy arena, focusing on issues related to providing expert care. Applies political skills to challenge the stakeholders who atempt to restrict practice 
¡Nurse politician-seeks an elective office or an appointment to a policy position
Term
Areas of Nursing Involvement
Definition

 

¡Agenda for healthcare reform
¡Reimbursement for services
¡Protection of civil and privacy rights
¡Illness prevention services, primary care services for women, children, and the elderly.
Term

 

Florence’s Influence
Definition

Crimean War:

Reduced mortality (Trained nurses Hospital sanitation Nutritious food)
Other areas: 
Engaged in research (not just nursing) by keeping biostatistics and other hospital records
Published several volumes leading to reforms in hospitals, workhouses, and infirmaries
Advocated improved conditions for nurses including housing, salaries, holidays, and retirement
Organized care
Term
Florence’s Influence Nursing Education
Definition

 

Nurses training school
Hospital model for nurses training
Recognized body of knowledge necessary for training
Advocated holism
Importance of environment
Two types of nursing--care of ill and promotion of health
Published “Notes on Nursing"
Advocated careful selection of students, paid instructors, curriculum including theory, supervised practice, and writing of case studies.
Term

 

US Training Programs
Definition

Shortage during Civil War resulted in Florence being contacted
After Civil War first training school--New England Hospital for Women and Children (1 year)
Trio:
Bellevue Training
Connecticut Training
Boston Training
Term

 

Dorothea Dix 1802- 1887
Definition

 

Superintendent of Women Nurses
Lead for 100 women to care for Civil War wounded
Mental health advocate
Term

 

Clara Harlowe Barton
(1821-1912)
Definition
-Founded Amer. Red Cross
Term

 

Mary Mahoney 1845-1926
Definition

 

Trained New England Hospital for Women & Children to become first black trained nurse
Term

 

Lavinia Dock 1858-1956
Definition

 

Joined Henry Street Settlement
Fiery political & social activist
 
staunch advocate of legislation to control nursing practice, Lavinia Lloyd Dock is also remembered for her outstanding contributions to nursing literature.
Term

 

Mary Adelaide Nutting
Definition

 

Chaired Committee on Nursing (WWI). Professor of Nursing Columbia University
 
First nurse to be a university professor accepted position as chair nursing education department at Teachers College Columbia University.
she became the first nurse ever to be
            appointed to a university professorship.
Term

 

Jesse Sleet (Scales)
Definition

 

Legendary public health nurse
Charter member of NYSNA 1901
Term

 

Isabel Hampton Robb
1860-1910
Definition

 

Organizer Johns Hopkins SON
Founded what later became known as ANA &NLN
 
First President of American Nurses Association and organizer of the original NLN.
Term

 

Annie Goodrich 1866-1954
Definition

 

1924 Yale SON--Dean with independent budget
Term

 

Mary  Breckinridge 1881-1965
Definition

 

introduced a model rural health care system into the United States in 1925. To provide professional services to neglected people of a thousand square mile area in southeastern Kentucky, she created a decentralized system of nurse-midwives, district nursing centers, and hospital facilities.
Term

 

Margaret Sanger 1879-1966
Definition

 

Founder of
American birth control movement
Term

 

Virginia Henderson 1897-1996
Basic Principles of Nursing Care
Definition

 

A modern legend in nursing, Virginia A. Henderson has earned the title "foremost nurse of the 20th century." Her contributions are compared to those of Florence Nightingale because of their far-reaching effects on the national and international nursing communities. She holds twelve honorary doctoral degrees and has received the International Council of Nursing's Christianne Reimann Prize, which is considered nursing's most prestigious award.
Term

 

Lydia Hall 1906-1969
Definition

 

An innovator in nursing practice, Lydia Eloise Hall established and directed the Loeb Center for Nursing and Rehabilitation at Montefiore Hospital in Bronx, New York, from 1963 to 1969. Through her research in nursing and long term care, Hall developed a theory that the direct professional nurse-to-patient relationship is itself therapeutic and that nursing care is the chief therapy for the chronically ill patient.
Term

 

Susie Walking Bear Yellowtail, RN
1903-1981

Definition

 

helped to bring modern health care to her own people and to end abuses in the Indian health care system, such as the sterilization of Native American women without their consent. She effectively communicated Native American culture and perspectives to non-Indians throughout the country then as well as throughout her public service career.
Term

 

Men’s Contributions
Definition

 

First clearly identifiable organization of nurses was a military nursing order called Knights Hospitallers of St. John of Jerusalem formed 1099 to accompany Crusaders
Term

 

James Derham
Definition

 

In 1783
a black slave,worked as a nurse in New
Orleans and saved the money to purchase his freedom.
He later studied medicine and became a respected physician in Philadelphia.
Term

 

Mary Grant Seacole 1805-1881
Definition

 

Jamaican-born nurse who
fulfilled her ambition to nurse soldiers in the Crimean war,
despite being denied the opportunity of enlisting
 with Florence Nightingale.
Term

 

Mabel Keaton Staupers
1890-1989
Definition

 

Worked for African-American Nurses to be accepted as full members of the military nursing corps & ANA
Term

 

Licensure
Definition
process by which an agency or government grants permission to qualified persons ro engage in a given profession or occupation.
Term

 

Certification
Definition
Validation of specific competencies demonstrated by a registered nurse in a defined area of practice
Term

 

Accreditation
Definition
A voluntary review process of educational programs or service agencies by professional organizations
Term

 

Accountability
Definition

 

being answerable to someone for something one has done” or not done.  “It means providing an answer to self, to the client, to the employing agency, to the nursing profession, and to society
Term

 

Responsibility
Definition

 

The ability to respond. The social force that binds you to your obligations and the courses of action demanded by that force
Term
Profession
Definition
work requiring advanced training and usually involving mental rather than manual effort. Usually has a code of ethics and a professional organization
Term
Professional accountability
Definition
In the shared govenrance model, a basic set of responsibilities of all professional nurses regardless of practice setting
Term
Professional socialization
Definition
The process of developing an occupational identity
Term
Carper's ways of knowing (4)
Definition

Carper’s ways of knowing in nursing

1. empirics

2. esthetics

3. personal knowing

4. ethics

provide a guide to holistic practice, education, and research.

 

Term

Potential reasearch questions related to Carper's ways of knowing: Empirical Research

Definition

 

Is a measurement of hope affected by variables

such as age, sex, culture, location, services,

supports, and the trajectory of grief?

 

 

 

What are the correlations, moderators and

mediators of hope during grief?

 

 

How effective is a hope intervention in

increasing the level of hope?

Term

Potential reasearch questions related to Carper's ways of knowing:

Esthetic Research

Definition

What are the processes of hope during

bereavement?

What is the main concern of bereaved

caregivers, relating to hope, and how do they

resolve this concern?

How effective and appropriate is a hope

intervention in a specific practice setting?

How do a group of bereaved palliative

caregivers socially construct the experience of

hope?

Term

Potential reasearch questions related to Carper's ways of knowing: 

Personal Knowing

Definition

What is the caregiver’s experience of hope after the

loss of a spouse?

How is the meaning of hope constructed by a

bereaved caregiver?

What are the processes of hope within the

bereaved caregivers’ social context?

How does race or social class affect the experience

and meaning of hope?

Term

Potential reasearch questions related to Carper's ways of knowing: 

Ethical Research

Definition

What is the context of care for the bereaved

palliative caregiver?

How effective, efficient, and equitable are the

services and interventions offered to bereaved

caregivers?

What are the rights of the bereaved palliative

caregiver in the context of the health care system?

What theories apply to the bereaved palliative

caregiver’s experience of hope, in an overall

evaluation of a system of care?

Term

Carper's Esthetics Approach

 

Definition

The esthetic approach, or the art of nursing, encourages

the examination and appreciation of the human

experience of health and illness.

Term

Carper's Ethics Approach

 

Definition

 

The ethical pattern of knowing in nursing emphasizes

matters of obligation and what ought to be done.

 

Evaluating the quality and effectiveness of care that is

currently being offered is an ethical responsibility—

what ought to be done,—with the goal of optimal care

and the promotion of health.

Term

 

Implementation
Definition

 

Action focused
Occurs within healthcare system
Managed care
Case management
Requires one to
 
Requires
Reflection
Critical thinking
In order to assure:
Safe, effective, and efficient care
Perform & Delegate
Term

 

Preparing the Patient for implementation
Definition

 

Reassess the need for intervention
Assess the client’s readiness
Explain to the client what is to take place
Term

 

Doing
Definition

 

Dependent
Independent
autonomy
accountability
Interdependent (collaborative)
coordination
Term

 

Learning
Definition

 

Needs are met
Ready and motivated
Actively involved
Conducive environment
Favorable emotional climate
Rapport
Term

 

Failure to Use New Knowledge
Definition

 

Don’t totally understand concepts
Cultural differences
Lack of support
Lack of confidence
Reluctance to bother others asking questions
Lifestyle that makes adherence difficult
Term

 

Tips for Enhancing Adherence to care plan
Definition

 

Accept the patient as s/he is
Ask what s/he wants to know and what are concerns
Be realistic
Do not assume
Promote patient confidence
Remind the patient change takes time
Term

 

Delegation
Definition

 

Assignment transfer of responsibility & accountability
Delegation transfer of responsibility w/o transfer of accountability
Three responsibilities
Appropriate delegation
Appropriate communication (verify understanding & address concerns)
Adequate supervision
Term
5 Rights of Delegation
Definition

 

Right task
One that is delegated for a specific person
Right person
Right person delegating to right person a task to be performed on or with the right person
Right circumstances
Appropriate patient setting, available resources, and other relevant factors considered.
Right direction/communication
Clear, concise description of the task, including objective, limits &expectations.
 Right supervision and evaluation
Appropriate monitoring, evaluation, intervention, as needed, and feedback.
Term

 

Supervision
Definition

 

First time supervise
Spot check
Retake vital signs
Check on bathing
Speak with patients
Frequent feedback especially on good work
Mistakes communicated privately with opportunity to explain
Term

 

Implementation is completed when nursing orders are?
Definition

 

Carried out
Recorded
Patient response to them noted and recorded
Term

 

Guidelines for Documenting
Care
Definition

 

Concise 
Accurate
Complete
Legible
Timely
Logical Identify patient
Term

 

Critical Paths
Definition

 multidisciplinary care plans outlining a patient's treatments and expected outcomes day by day

 

Activities
Nutrition
Tests/Consults
Medications
Teaching
Treatments
Discharge Planning
Term

 

SBAR
Definition

 

Situation
Background
Assessment
Recommendation
Term

 

Hand Off-Reporting
Definition

 Read the shift nurses’ notes and get report from direct caregivers before giving report.

Use concise phrases.  Use acceptable terminology that all participants will understand.  Allow opportunity for questions
Conduct report where only caregivers can hear report.
Be definite.  Avoid apparently, appears to be.  Substantiate with facts.
Have the Kardex or patient profiles available for more detailed information
Help incoming shift organize by pointing out interventions due and priority events coming.
Respect privacy of patient, if not related to nursing care
Describe reported symptoms accurately.  Use the patient’s words. 
Be brief. Don’t repeat all background information available or routine care 
Term

 

Items to Include in Handoff
Definition

 Identifying patient data

Diagnoses
Patient Condition
Intervention
Outcomes
Discharge plans
Family/care support
Timely intervention
Term

 

Change of Shift
Definition

 

Identifying patient data
Diagnoses
Patient Condition
Intervention(new orders)
Outcomes
Discharge plans
Family/care support
Timely intervention (treatments to be done by oncoming shift)
Term
Reporting to Physician
Definition

Situation: What is going on with patient
Concern-why? Vital signs Presence or absence of signs and symptoms of potential complications

 

Background Patient Condition (Data related to current problems only) & your interventions
Current status Mental Status Skin Oxygen-Pulse oximetry reading
Assessment What do you think?  
Recommendation to physician Tests
Treatment changes Medications
Term

 

Standards
Definition

 

 
Both describe what is acceptable/desired
Basis for comparison
Describes nursing care
May be broad or specific
ANA standards is example
Model of what should be done
Term

 

Criteria
Definition

 

Measurable or observable qualities that describe specific:
Skills
Knowledge
Behavior
Attitudes
Both standards and criteria describe what is acceptable/desired
Basis for comparison
Describes expected nurse or client behaviors
Specific, measurable
Patient outcomes on a care plan
Valid and reliable
Term

 

Assessment
Definition

 

Before interventions
Make nursing dx
Determine health status
Term

 

Evaluation
Definition

Evaluation is “the planned, ongoing, purposeful activity in which client’s and health care professionals determine the client’s progress toward goal achievement

Done:  

After interventions
Evaluate goal achievement
Compare new status to desired status
Term

 

Structure
Definition

 

What effect do environmental and organizational characteristics have on the quality of care?
Setting
Examples
Visible exit signs
Resuscitation carts on each unit
Family waiting room on each floor
Term

 

Process
Definition

 Is care relevant to patients’ needs? Is it appropriate, complete, and timely?

Caregiver
Examples:
Initial interview completed within 8 hours
Responses to medication charted
Nurse introduces self before giving care
Term

 

Outcome
Definition

 

What are the patient responses to the care?
Patient responses
Examples:
Temp less than 100 degrees F 24 hours after surgery (Expected 90%)
Patient will not fall during hospital stay (95%)
Term

 

Modification
Definition

 

Modification is a change one makes to interventions if they are not meeting goals.
Term

 

Which of the following is true of the implementation phase of nursing process?
Definition

 

A. its effectiveness depends on the quality of assessment, diagnosis, and evaluation that have preceded it
B. it occurs separately from other phases of the nursing process
C. it is directed by physician orders
D. it includes the actual nursing activities and rationale
Term

How do the assessment and evaluation phases of the nursing process differ?
Definition

 

A. Data is used to make a diagnosis in assessment, and data is used to determine the effectiveness of care in evaluation.
B. Nursing data is used in conjunction with medical data in the assessment phase and independently of the medical data in the evaluation phase.
C. They are both part of the nursing process but they are different phases.
D. They do not differ.
Term

 

Person:
Definition
individual, family or community
Term
Environment:
Definition
all the many factors, such as physical or psychological, that influence life and survival
Term
Health:
Definition
a person’s physical, mental, and social well-being, a continuum
Term
Nursing:
Definition
the provision of health care services, focusing on the maintenance, promotion, and restoration of health
Term
System—
Definition
Set of interrelated parts that come together to form a whole
Term
Input—
Definition
Information, energy, or matter that enters a system
Term
Output—
Definition
The end result or product of a system
Term
Feedback—
Definition
The information given back into a system to determine whether or not the purpose of the system has been achieved.
Term
Evaluation—
Definition
Measuring the success or failure of the output and consequently the effectiveness of the system
Term
Rosenstock’s Model
Definition
Evaluate vulnerability
Seriousness
How effective health behavior might be
Trigger event that precipitates behavior
Term
Theory
Definition
is a group of related concepts, definitions, and statements that propose a view of nursing phenomena from which to describe, explain, or predict outcomes. Theories represent abstract ideas rather than concrete facts.
Term
Model
Definition
is a symbolic representation of a reality.
Term
Conceptual framework
Definition
is a group of concepts that are broadly defined and systematically organized to provide a focus, a rationale, and a tool for integration and interpretation of information.
Term
Philosophies
Definition
provide broad, general views of nursing that clarify values and answer broad disciplinary questions
Term

 

Roy Adaptation Model
Definition

 

PERSON-
Man as dynamic system with input and output 
HEALTH -
Continuum-the ability to adapt successfully to illness
ENVIRONMENT -
Both internal and external stimuli that affect behavior
NURSING -
Multistep process that helps the client adapt and reach the highest level of functioning
Term
Orem Self-Care
Definition

PERSON-Humans—biologic, psychological social beings with the ability for self-care

HEALTH -Ability to live life to the fullest through self-care

ENVIRONMENT-The medium through which the client moves

NURSING-Helping the client achieve health through assistance in self-care activities

Term
King Goal Attainment
Definition

PERSON-Person exchanges energy and information with the environment to meet needs HEALTH-Dynamic process to achieve the highest level of functioning.

ENVIRONMENT-Personal, interpersonal, and social systems and the external physical world

NURSING-Dynamic process to identify and meet the health care needs of the person

Term
Watson Model of Human Caring
Definition

PERSON Individual has needs, grows, and develops to reach a state of harmony

HEALTH Dynamic state of growth and development leading to full potential as a human being ENVIRONMENT Those factors that a client must overcome to achieve health

NURSING Science of caring that helps clients reach their greatest potential

Term
Johnson Behavioral Model
Definition

PERSON Person-a behavioral system that is and organized and integrated whole composed of seven subsystems

HEALTH A balanced and steady state within the behavioral system of the client

ENVIRONMENT All those internal and external elements that affect the client behavior

NURSING Activities that manipulate the environment and help clients achieve the balanced state of health.

Term
Neuman Health Care Systems
Definition

PERSON An open system that constantly interacts with internal and external environment.

HEALTH Relatively stable internal functioning of the individual in a high state of wellness (stability) ENVIRONMENT Internal and external stressors that produce change in the client

NURSING Identifies boundary disruption and helps clients in activities to restore stability.

Term

 

The Structure of Caring
Definition

Maintaining Belief = Attitudes to person to clients

Knowing = Clinical Condition the situation the client

Being With= Message (Congruence,Acceptance,Empathy)
Doing For & Enabling-Therapeutic actions or interventions
Client Well-being=Intended Outcome
 

Term

 

Health promotion
Definition

 

Services that encourage a condition of maximum physical, mental, and social well-being.
Term
Illness prevention
Definition
Services aimed at diminishing the likelihood that an individual’s physical, emotional, social, and intellectual functions will become impaired.
Term
Diagnosis and treatment
Definition
Services aimed at identifying health problems/illnesses and alleviating them
Term
Rehabilitation and long-term
Definition
Rehabilitation provides services aimed at restoring an individual or body part to normal or near normal function following a disease or an accident. Long term care provides care for individuals, such as those with Alzheimer’s disease, who require lengthy assistance in the maintenance of activities of daily living.
Term
3 main classifications of health care agencies
Definition
Governmental (federal, state, local) or public agencies vs. voluntary (private) agencies

For profit or non-for-profit

Level of health care services provided (primary, secondary, tertiary, or subacute)
Term
Organizational Structures of Health Care Agencies
Definition
Board of directors
Chief Executive Officer (CEO)
Medical staff
Chief of staff
Nursing staff
Chief Nurse Executive (CNE)
Term
Shared governance model
Definition
Right and responsibility to govern own work and time—modeled after 5 accountabilities. Shared decision-making and shared accountability. Cannot have one without the other
Term
Nursing Roles
Definition
Provider of direct, hands-on care to patients
Educator of patients, families, communities, other staff, students, businesses, and government
Counselor providing support for patients and families
Manager of Patient Care for Individual Patients and Groups of Patients and Manager of Scarce Resources
Researcher investigating effectiveness of current an potential nursing actions
Collaborator with patients and health team
Change agent/intrapreneur for changes in the nursing system
Entrepreneur for own business.
Patient Advocate.
Term

 

Functional Nursing
Definition

 

A system of nursing care delivery in which each worker has a task, or function, to perform for all patients.
Term

 

Team Nursing
Definition

 

A system of nursing care in which a group of nurses and ancillary workers are responsible for the care of a group of patients during a specified time period, usually 8-12 hours.
Term

 

Primary Nursing
Definition

 

A system of nursing care delivery in which one nurse has responsibility for the planning, implementation, and evaluation of the care of one or more clients for 24 hours a day for the duration of the hospital stay.
Term

 

Case Management
Definition

 

Nurses are responsible for coordinating services provided to patients in a cost effective manner
Term

 

Nurses Role in Managed Care
Definition

 

APNs-primary care providers
Case managers
Telephone triage
Utilization reviewers
Rehabilitation
Home health
Term

 

Methods of Payment for Healthcare
Definition

 

Personal payment
Medicaid—jointly funded federal and state public insurance for those below the poverty level and with disability.
Medicare—federally funded public hlth insurance
Private insurance—privately owned company
Workers compensation—federally mandated insurance system for workers injured on the job
Term

General guidelines for evaluating national health insurance proposals
Definition

 

Uniform set of benefits
Continuous coverage
Cost control mechanisms
Cost-effective care
Adequate access
Emphasis on quality
Incentives for healthy life style and preventive care
Term

 

Strategies for changing health care delivery
Definition

 

Legislating health care costs and insurance (Kassebaum-Kennedy Act 1996—HIPAA)
· Universal insurance
· Using fewer nurses and more UAPs
·  Expansion of the role of nurse to primary care provider
Term

Standards of reasoning

 

(#1 a)

Definition

a set of intellectual standards used to explore thequality of thinking withn the nursing process:

Clarity-gives an example;assists in accuracy of info

Accuracy-truth of a statement;validity of a statement

Precision-exactness

Relevance-how does the info relate

Depth-are complexities of situation addressed

Breadth-other view points considered

Logic-makes sense

Term

Types of nursing knowledge and ways of knowing

 

 

(#1 b)

Definition

Scientific knowledge-research findings as well as conceptual models of nursing, theoretical explanations of other disciplines

Art of nursing-The way in which nurses use knowledge. Scientific plus feelings gained by subjective experiences

Ethical knowledge-knowldege of professional standards of conduct and processes for determinign right and wrong actions. A code of ethics (set of written goals and values) assists nurses in being accountable to clients

Personal Knowledge-Knowing one's self

Practice wisdom-acquired form intuition, tradition, authority, trial and error, and clinical experience

 

Term

Guidelines for developing critical thinking

 

(#1 c)

Definition

Perform a self assessment-

   Independent thinking-

   Intellectual humility-accept what you don't know

   Intellectual courage-examine own beliefs

   Intellectual empathy-

   Intellectual integrity-consistency in thinking          

       standards you apply

   Intellectual perseverence-exploring to gain insight

   Intellectual curiosity- attitude of inquiry

   Faith in reason-well reasoned thinking leads to

       trustworthy conclusions

   Fair mindedness-treating all viewpoints alike without 

       referencing your own vested interest

   Interest in expanding thoughts and feelings-emotions

       can influence thinking and all thoughts create 

       some kind of feeling

Tolerate dissonance and ambiguity-suspend judgement and see all sides

Seek situations where good thinking is practiced-attend conferences or educational settings that support all sides of issues as well as opposing view points.

Create environments that support critical thinking-encourage difference of opinion

Practice critical thinking-

Term

Attributes of critical thinkers

 

(#1 d)

Definition

Rationality and reason

Reflection

Skills and attitudes

Creative thinking knowledge

Term

History, education pattern and social context;

Differnetiation of nursing from medicine

 

(#2 a)

Definition
Nursing allows entry of persons with less than baccalaureate level education to practice in the profession
Term

Recommendation of ANA in 1965 position paper titled "Educational Preparation for Nurse Practitioners and Assistants to Nurses"

 

(#2 c)

Definition

4 recommendations:

  1. Edcucation of liscenced practiotioners should take place in institutions of higher learning
  2. Minimum prep for beginning professional nursing practice should be a baccalaureate in nursing
  3. Minimum prep for beginning technical nurses should be an associates degree in nursing
  4. Health assistant education should consist of short, intense programs in vocational schools and institutions rather than on the job
Term

Evaluation/accreditation of nursing programs

 

(#2 d)

Definition
In addition to state board approval, some institutions voluntarily seek accreditation. The accreditation agency compares educational quality of programs with established standards and criteria. Two agencies are involved in accreditation: NCNAC and the Comission on Collegiate Nursing Education
Term

Differentiate between LPN and RN

 

(2 f)

Definition
Liscensure and education. LPNs work under a limited scope of practicce
Term

Scope of practice

 

(4 d)

Definition
a terminology used by state licensing boards for various professions that defines the procedures, actions, and processes that are permitted for the licensed individual. The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency. Each state has laws, licensing bodies, and regulations that describe requirements for education and training, and define scope of practice.
Term

Landmarks in the history or nursing education

 

(2 i)

Definition

1860- Florence Nightengale founded the first organized program to educate nurses (St Thomas Hosp)

1872- "Famous trio" 1st year long nursing school established in the US; Bellevue Hosp, New England Hosp, Massachusetts General

1873- Melinda Anne RIchards became first nurse to graduate in the US

1899- Teachers College, Columbia University, offered the first graduate course in hospital economics for nurses

1907- Mary Adelaide Nutting became the first nursing professor at Teachers College, Columbia University

1909- First baccalaureate degree established at univerisity of Minnesota

1923- Goldmark report published, focusing on hospital control of nursing and lack of proper teacher preparation

1924-Yale University established the first nursing school as a separate university department with its own dean: Annie W. Goodrich

1932- First doctoral degree in nursing education (EdD) was granted by Teachers College.

1934-First PhD program in nursing was initiated by New York University

1948-Esther Lucille Brown's report "Nursing for the future" was published recommending that basic nursing programs be situated in colleges and universities rather than hospitals

1952-First associates degree nursing program, based on Dr. Mildred Montag's model was established

1965- ANA sissued a position paper advocating the baccalaureate degree as a minimum educational preparation for entry into nursing practice

Term

Describe the history of associate degree nursing programs

 

(2 j)

Definition
In 1952, Dr. Milldred Montag created a model which was adopted during WWII in response to nursing shortages and also fueled by the community college movement of the early 50s
Term

Describe external and articulated programs

 

(2 k)

Definition

External programs- distance learning (excelsior)

Articulated programs- "ladder" LPN, ADN, BSN, MSN

 

both are helpful for nurses who work but needed options to progress in the profession

Term

Compare and contrast liscensure and certification

 

(3 a)

Definition

Both are forms of credentialing for nurses.

 

Liscensure- refers to state regulation of the practice of nursing and is required of individuals at the entry point of practice with periodic renewal. It assures public safety by assessing basic and continuing competence.

 

Certification- goes beyond liscensure by validating a high level of knowledge and proficiency in a particular practice area. It is pursued voluntarily by individual nurses and therefore is a credential that has professional but not legal status

Term

Describe nursing as a profession. Does it meet the criteria?

 

(3 b)

Definition
Professions are work requiring advanced training, usually involve mental rather than physical work, usually have a code of ethics, and professional organizations. Nursing meets all of this criteria.
Term

Describe the characteristics of a professional

 

(3 c)

Definition
Professionals are highly educated and continue to seek continued education. They also are autonomous, accountable, use mental creativity, make decisions, are civil, collaborate, are consistent, current on developments within their chosen profession and are involved in the profession's development
Term

ANA, NLN, AACN, STTI, and ANCC and their functions

 

(3 d)

Definition

ANA-American Nurse Association is a professional organization that addresses ethics, clinical standards, public policy, and the economic and general welfare of nurses. Membership is limited to nurses.

NLN-National League for Nursing is a national organization that seeks to advance the profession of nursing through advocacy and improving educational standards for nurses. Non-nurses may be members.

AACN-American Association of Colleges of Nursing is a national organization devoted to advancing nurse education at the baccalaureate and graduate levels

STTI-Sigma Theta Tau International is an International honors society for nursing

ANCC-American Nurses Credentialing Center is the credentialing arm of the ANA; responsible for certification of individual nurses and approval of organizations as continuing education providers

Term

Discuss Flexner and Hall's contribution to the definition of profession

 

(3 e)

Definition

Flexner stipulated that a profession is 1)intellectual and has a high charge of responsibility 2)based on a body of knowledge that can be learned 3)Practical and theoretical 4)Can be taught through highly specialized education 5)Strong internal organization of members 6)practitioners are altruistic

 

Hall stated that 1) professional organization is the primary point of reference 2) belief in value of public service 3) belief in self regulation 4)comittment to profession that goes beyond economic incentive 5)sense of autonomy in practice. also noted that each profession needs its own measure of professionalism.

Term

Discuss barriers to professionalism in nursing

 

(3 f)

Definition

Variability in educational preparedness-members with various educational backgrounds are allowed to practice:ADN vs BSN

Gender issues-Lower numbers of male nurses, and outmoded thinking with resultant devaluation of "womens work" in society

Historical influences- Military and religious ties lead to an "obedient" mind set wheras questioning and critical thinking are needed

External conflics-nurses must strive for collaboration, not competition with physicians and other health personnel with whom they work

Internal conflicts- Fragmentation by sub-groups and dissension; rivalry among diploma-educational, associte degree- educated adn baccalaureate -educated nurses saps the vitality of the profession

Term

Discuss nursing's contract with society

 

(3 g)

Definition
Obligation to the recipients of services. Nursing's social policy statement serves as a framework for understanding professional nursing's relationship with society and its obligation to those who recieve professional nursing care
Term

responses of a family and patient experiencing a serious illness

 

(6 a)

Definition

illness creates a variety of emotional responses for the patient:

Guilt

Anger

Anxiety

Stress

Family responses—the family experiences increased stress; family problems are seen as increasing/worsening with illness

Emotional responses:

--Frightened

--Angry/guilty

--Resentful

--Feelings of hopelessness

--Distrust of healthcare providers

 

Behavioral responses:

--critical and demanding behavior

--withdrawal from the situation

--confusions

--deny seriousness of patient’s illness

--promote dependence by patient

Caregiver stress:

common in families of patients with prolonged, progressive illnesses, like dementia; is a role strain

 

 

 

 

Term

a)      Discuss assault and battery as it relates to nursing (pp 87)

Definition

1)      Occasionally the basis for legal action against a nurse defendant

2)      Assault- a threat or an attempt to make bodily contact with another person without the persons consent; assault precedes battery; it causes the person to fear that battery is about to occur

3)      Battery- the assault carried out; the unprivileged touching of one person by another; actual harm or injury may or may not occur as a result of assault and battery

4)      Example: a nurse threatens a patient with a vitamin injection if he/she does not eat his meals (assault); actually giving the injection against the patient’s will = battery (even if there is a physician’s order)

(1)   By common law and by statute, informed consent is needed in the health care context as a defense to battery

Term
Assault-
Definition

      a threat or an attempt to make bodily contact with another person without the persons consent; assault precedes battery; it causes the person to fear that battery is about to occur

 

 Example: a nurse threatens a patient with a vitamin injection if he/she does not eat his meals (assault)

Term
Battery-
Definition

    the assault carried out; the unprivileged touching of one person by another; actual harm or injury may or may not occur as a result of assault and battery

   Example: actually giving an injection against the patient’s will = battery (even if there is a physician’s order)

Term
Discuss assault and battery as it relates to nursing (pp 87)
Definition

  By common law and by statute, informed consent is needed in the health care context as a defense to battery

Term

Discuss the ways in which nurses can become more political (pp 370)

Definition

1)      Nurse citizens

2)      Nurse activists—take a more active role than nurse citizen

3)      Nurse politicians— desires to develop the legislation, not just influence it

Term

Discuss the ways in which nurses can become more political (pp 370)

 

Nurse citizens

Definition

Voting; registration and voting in every election

Keep informed about health care issues

Speaking up when services or working conditions are inadequate

Participating in public forums that advocate for health and human services

Joining politically active nursing organizations

Join a political party

Know local, state, and federal elected officials

Involvement in community activities

Term

Discuss the ways in which nurses can become more political (pp 370)

 

Nurse activists—take a more active role than nurse citizen

Definition

Join politically active nursing organizations

Contacting a public official through letters, e-mails, or phone calls

Registering other people to vote

Contributing money to a political campaign

Lobbying

Forming/joining coalitions that support an issue of concern

Writing letters to the editor of a local newspaper

Asking legislators to visit the workplace

Term

Discuss the ways in which nurses can become more political (pp 370)

 

Nurse politicians— desires to develop the legislation, not just influence it

Definition

Run for elective office

Seek appointment to a regulatory agency

Be appointed to a governing board in the public/private sector

Use nursing expertise as a front-line policy maker who can enhance health care and the profession

Term
malpractice
Definition
Negligence that occurs when expected standards of care are not met by professionals (Unintentional Tort)
Term

Discuss the elements necessary to prove a malpractice case

 

From Box 4-3 pp 86

 

Failure to follow standards of care

Definition

Failure to:

Perform a complete admission assessment or design a plan of care

Adhere to standardized protocols or institutional policies and procedures

        -Using improper injection site

        -Follow a physician’s verbal or written orders

       

Term

Discuss the elements necessary to prove a malpractice case

 

From Box 4-3 pp 86

 

Failure to use equipment in a responsible manner

Definition

Failure to:

            - Follow the manufacturer’s recommendations for operating equipment

             - Check equipment for safety before use

             - Place equipment properly during treatment

             - Learn how equipment functions

       

Term

Discuss the elements necessary to prove a malpractice case

 

From Box 4-3 pp 86

 

Failure to communicate

Definition

Failure to:

-Notify a physician in a timely manner when conditions warrant it

-Listen to patient complaints and act on them

-Communicate effectively with a patient (ex. Inadequate or ineffective communication of discharge instructions

-Seek higher medical authorization for a treatment

Term

Discuss the elements necessary to prove a malpractice case

 

From Box 4-3 pp 86

 

Failure to document, including failure to note in the patient’s medical record

Definition

Not recording:

-Patient’s progress and response to treatment

-A patient’s injuries

-Pertinent nursing assessment information (drug allergies)

-A physician’s medical orders

-Information about telephone conversations with physicians (time, content of communication, actions taken)

Term

Discuss the elements necessary to prove a malpractice case

 

From Box 4-3 pp 86

 

Failure to assess and monitor

Definition

-Not completing a shift assessment

-Not implementing a plan of care

-Not observing patient’s ongoing progress

-Failure to interpret a patient’s signs and symptoms

Term

Discuss the elements necessary to prove a malpractice case

 

From Box 4-3 pp 86

 

Failure to act as a patient advocate

Definition

-Not questioning discharge orders when a patient’s condition warrants it

-Not questioning incomplete or illegible medical orders

-Not providing a safe environment

Term
ANA’s Code of Ethics for Nurses with Interpretive Statements
Definition

Describes 9 ethical provisions that cover all aspects of nursing practice; adds a number of clarifying statements for each of the nine provisions; knowledge of your professional organization’s code of ethics is an important protection

Term
4 Documents you should own
Definition

1. Copy of the state nurse practice act

2. Nursing's social policy statemtne

3. Nursing: Scope and Standards of Practice

4. ANA's COde of Ethics for Nurses with interpretive statements

Term
9 provisions of the code of ethics for nurses
Definition

1.Practice with compassiona dn respect for all

2. Primary commitment is to the patient (regardless of number of patients)

3. Promote, advocate, and strive to protect health, safety, and rights of a patient

4. Be responsible and accountable for individual nursing practice; appropriately delegate tasks

5. Nurse owes the same duty to self as they do others; preserve integrity, safety, competence and continue professional growth

6. Participate in establishing, improving and maintaing helath care

7. Participate in the advancement of the profession through contributions to practice, education etc...

8. Collaborate with other helath professionals and the public in promoting health efforts

9. The profession as represented by professional organizations and its memebrs is responsible for articualting nursing values, maintaining integrity of the profession and its practice and for shaping social policy

 

Term

Describe the 4 documents that all nurses should own (box 4-5 pp 95)

Nursing: Scope and Standards of Practice (published by ANA)

Definition

-Expands on the social policy statement; focuses on defining and delimiting clinical practice and its safe implementation;

-Is used in legal cases to determine whether or not a nurse has met the “standard of care” in a particular case

Term

Describe the 4 documents that all nurses should own (box 4-5 pp 95)

Nursing’s Social Policy Statement

Definition

Lays out the most current definition of nursing; the knowledge base for nursing, including specialized and advanced practice roles; and the regulation of practice; has considerable impact on the national scope of practice

 

                 Represents and “expression of the social contract between society and professional nursing

Term

Describe the 4 documents that all nurses should own (box 4-5 pp 95)

Nurse practice act

Definition

Being familiar with the law your state is a key safeguard against accidentally overstepping the limits of practice while understanding the full set of responsibilities that your state requires you to fulfill

Term
Ethics
Definition

what actions an individual should take; process oriented and involve critical analysis of actions

Term
Values
Definition

attitudes, ideas or beliefs that an individual or a group holds and uses to guide behavior; usually expressed in terms of right and wrong, hierarchies of importance, or how one should behave; freely chosen by individual

Term
Morals
Definition
rules of conduct to be used in situations where a decision about right and wrong must be made; provide standards of behavior that guide actions of an individual or social group. (ex: one should not lie); morals are learned over time and are influenced by life experiences and culture
Term

Describe a model nursing practice act

Definition

1. Defines the practice of professional nursing

2. Sets the minimum educational qualifications and other requirements for liscensure

3. Determines the legal titles and abbreviations nurses may use

4. Provides for disciplinary actions of liscencees ofr certain causes

Term

Veracity

Definition

 Telling the truth; fundamental to the development and continuance of trust; necessary to basic communication

 Example: In nurse-patient relationships nurses are supposed to be honest with their patients; ethical dilemmas arise when health care systems put limits on what a nurse can tell a patientà is it unethical to withhold information from a patient, especially when patients ask for information about their condition or diagnosis… A nurse may remain truthful by stating something like, “Dr. So-and-so always prefers to discuss his findings with his patients directly”

Intentional deception is what is really wrong; there are exceptions to the principle of veracity—the nurse can withhold information if the patient asks not to be told the truth (involves principles of beneficence and nonmaleficence) (pp 112). Or if a patient is mentally incompetent, autonomy and the capacity for self-determination are diminished, justifying withholding of information (pp 112).

Term
Fidelity
Definition

Faithfulness or honoring one’s commitments or promises; for nurses, this specifically means fidelity to patients;

Nurses must be faithful in keeping their promises of respecting all individuals, upholding the Code of Ethics for Nurses (ANA), practicing within nursing scope of practice, maintaining competence in nursing, abiding by the policies of the employing institution, and keeping promises to patients

 Example: nurse-patient relationship

(a)    One is faithful to the promises, agreements and commitments made, building trust that is essential in the relationship. The harmful consequences of the promised action must be weighed out against the benefits of promise keeping

Term
Justice
Definition

(1)   Equals should be treated the same and that unequals should be treated differently

(a)    Most common issues about justice relates to allocation of resources; seen in health disparities among ethnic minorities with regard to types of treatment and services that are available àour health care system is not equitable among racial groups

Term
Nonmaleficence
Definition

(1)   Based of Hippocratic Oath; nurse must not act in a manner that would intentionally harm the patient

(2)   Examples (and possible conflicts): chemotherapy and bone marrow or stem cell transplantation—both pose a risk for opportunistic infections, but possibility of achieving a cure of disease may justify temporary harm (principle of double effect)

Term
Beneficence
Definition

1)      “doing of good;” may conflict with other ethical principles, mainly autonomy

Term
Autonomous actions by a patient
Definition

(1)   deciding to refuse treatment; giving consent for treatment or procedures; obtaining information regarding treatment

Term
Autonomy
Definition

1)      --  individuals have the right to determine their own actions and the freedom to make their own decisions; respect for the individual is the cornerstone

Term
Explain cost containment efforts and impact on nursing
Definition

Nurses play an important role in controlling health care costs

-Enhancing cost awareness; posting the costs of supplies on shelves, making staff aware of lest costly alternatives

-Nurses are positioned to help patients make cost-effective choices: question repetetive testing, generic drugs vs. name brand drugs, early detection of probelms to avaoid re-hospitalizations

-In both inpatient and outpatient settings, organizing the flow of patients and thus maximizing efficiency represents a huge cost savings.

Term
Discuss healthcare cost escalation
Definition

(1)   Inflation

(2)   New, expensive technologies and drugs

(3)   Increase demand

(4)   Demographic changes

(5)   Fraud and payment system abuse

Term
Discuss the relevance of supply and demand as well as price sensitivity to healthcare costs
Definition

1)      Ineffectivness of both these concepts in relation to our healthcare: when someone other than the consumer pays, demand can increase because the consumer is insensitive to cost; economic equilibrium is upset because consumers use more health care services

Term
Supply and demand
Definition
Economic system has 2 parts: suppliers (who provide services and goods) and consumers (who demand and use goods and services)
Term
Price sensitivity
Definition

example: sliding scale payment option

Health insurance  created a third-party payment— which removed price sensitivity from the concern of most health care consumers since they only pay a portion of the actual cost

Term

 Patient-centered care

Definition

(1)   Contemporary care delivery model implemented by a multidisciplinary team of health professionals; focuses on patient’s right to individualized care that takes his or her values into belief when planning and providing care; more an attitude than a particular model of care: attitude = patients’ needs have priority over institution’s needs

Term

Advantages of  Patient-centered care

Definition

(a)    Expedites care

(b)   Promotes patient convenience

(c)    Capitalizes on professional competence of team members

(d)   Emphasizes continuum of care and reduces fragmentation of care

(e)    Uses resources efficiently

(f)    Fosters teamwork, collaboration, and communication

Term

Disdvantages of  Patient-centered care

Definition

(a)    Requires “right staff at the right time” to meet patient’s needs

(b)   Difficult to explain; uses several models of care delivery

(c)    Requires a lot of RNs; must have both clinical and management skills

Term

Case management nursing

Definition

(1)   Began in the late 1980s in order to improve the cost-effectiveness of pt care; allows the nurse to oversee pt care and manage the delivery of services from all health care disciplines throughout a patient’s illness

Term

Internal vs. external approach to Case management nursing

Definition

(a)    Internal= nursing case managers serve as primary nurses for pts in an identified diagnostic group (spinal cord injury); critical paths are used for all patients with this approach

(i)     Goal= treat each patient by using best practices to reduce the length of stay à reducing costs

(b)   External- nurse case managers are part of a large network; they partner with patients and their families to achieve the goal of preventing hospitalizations à reducing costs and minimizing disruptions to the patient’s life and family

Term

Advantages and disadvantages to Internal and external approaches to Case management nursing

Definition

(a)    Advantages-  box 14-7 pp 345

(i)     promotes interdisciplinary collaboration

(ii)   Increases quality of care

(iii) Cost-effective

(iv) Eases patient’s transition from hospital to community services

(v)   Nurse has increased responsibility

 

(a)    Disadvantages-

(i)     Requires additional training

(ii)   Requires nurses to be off the unit for periods of time

(iii) Is time-consuming

(iv) Most useful only with high-risk patients and high-cost/high-volume conditions

 

Term

Primary nursing

Definition

(1)   Developed in 1970s as a result of the increased acuity of hospitalized patients; designed to promote an identified nurse for every patient; goal= deliver consistent, comprehensive care by identifying one nurse who is responsible, has authority, and is accountable for the patient’s nursing outcomes

 

How it works: each new admit is assigned to a primary nurse; primary nurses then asses their patients and plan their care; while on duty, they care for their pts and delegate responsibility to associate nurses when they

 

 

Term

Advantages and disadvantages to

Primary nursing

Definition

(1)   Advantages- (box 14-6 pp 344)

(a)    high patient and family satisfaction

(b)   promotes RN responsibility, authority, accountability, and autonomy

(c)    Nurse cares for entire patient

(d)   Good nurse-client relationship

(e)    Promotes client-centered decision making

(f)    Increases coordination and continuity of care

(g)   Promotes professionalism

(h)   Promotes job satisfaction and a sense of accomplishment for nurses

(2)   Disadvantages-

(a)    Difficult to hire all RN staff

(b)   Expensive to pay all RN staff

(c)    Nurses are not familiar with other patients à making it hard to cover

(d)   May create conflicts between primary nurses and associate nurses

(e)    Stress of round the clock responsibility

(f)    Heavy responsibility—especially for new nurses

Term
Team nursing
Definition

(1)   Nurses were assigned as a team to a defined group of patients; team usually consists of a RN (the team leader), an LPN, and one of more PCTs

(a)    The team leader- ultimately responsible for all the care provided; delegates certain patients to each team member

(b)   This system is still used today, but the model is often modified

(c)    Positives- (box 14-5 pp 343)-

(i)     Potential for building team spirit

(ii)   Provides comprehensive care

(iii) Each worker’s abilities are used to the fullest

(iv) Promotes job satisfaction

(v)   Decreases nonprofessional duties of RNs

(d)   Negatives-

(i)     Ongoing need for communication among team members requires commitment of time

(ii)   All team members must promote teamwork, or team nursing is unsuccessful

(iii) Team composition varies from day to day- may be confusing and disruptive and decrease continuity of care

(iv) May result in blurred role boundaries and resulting confusion and resentment

Term

Functional nursing

Definition

(1)   This grew out of a need to organize care for large numbers of patients; focus is on organizing and distributing tasks of care among the staff

(a)    Goal: efficient management of time, tasks and energy

(2)   Personnel work side by side, each performing one or two assigned tasks for all the patients on the unity.

(3)   Positives- (box 14-4 pp 342) saved hospitals money; efficient: can complete many tasks in a defined time frame; proficient: workers only perform tasks they are educated to do and become very efficient; promotes organizational skills: each worker must organize his/her own work; promotes worker autonomy

(4)   Negatives- (pp 342)

(a)    Lacks holistic view of patient—patient care was fragmented because health care providers were task oriented and not focused on the whole patient; a patient could not identify one person as “my nurse”

(b)   Lacks continuity—patients often do not know who their nurse is

(c)    Care is fragmented

(d)   Does not support professional practice aspects of nursing

(5)   May still be used in some settings, but it’s popularity is fading; may be used when there are few staff members available

Term
managed care
Definition
Any system that manages healthcare delivery with the aim of controlling costs. Managed care systems typically rely on a primary care physician who acts as a gatekeeper through whom the patient has to go to obtain other health services such as specialty medical care, surgery, or physical therapy.
Term

Illness prevention vs. Health promotion and management

Definition

(1)   Prevention services address health problems after risk factors are identified; health promo services seek to prevent development of risk factors

Term
Illness Prevention
Definition

reduce the impact of identified risk factors on a person’s health and well-being; require participant’s active participation.  

Examples—Community health programs; promotion of healthy lifestyles to counteract risk factors; occupational safety programs ( use of eye protection for work that endangers the eyes); Environmental safety programs (proper disposal of hazardous waste); Legislation that prevents injury or disease (seat belts/child restraint laws, motorcycle helmet laws)

Term
Early Detection
Definition

a subcategory of health promotion and maintenance; detection of warning signs indicating the presence of a disease in early stages; allows treatment to be minimal and less costly and fosters positive treatment outcomes

Examples: mammograms; vision and hearing screening; cholesterol screening; periodic histories and physical exams; blood glucose screenings; osteoporosis screening

Term
Health Promo
Definition

assist patients to remain healthy, prevent diseases and injuries, detect diseases early, and promote healthier lifestyles; require patient participation and cannot be performed solely by health care providers.

 

examples: health education programs (prenatal classes); Exercise programs; Health fairs; Wellness programs (worksite and schools); Nutrition classes

Term
Describe the independence-dependence continuum
Definition

1)      Patients’ need for dependence are unrelated to the severity of their illnesses

(1)   Patients may say “They don’t know what they are talking about. I don’t need to be in bed, and I don’t need to take that medicine.” These two sentiments are at the opposite ends of the dependency continuum.

(2)   People who perceive themselves as helpless are  more willing to submit to health care staff and do what they are told; those who are used to being independent may resent the enforced dependency of hospitalization and illness

Term
professional boundaries
Definition

1)      Boundary issues are “the spaces between nurse’s power and the client’s vulnerability” (as defined by NCSBN).

2)      Nurse-patient relationships can be plotted on a continuum of professional behavior that ranges from under-involvement (distancing, disinterest, neglect) through a zone of helpfulness (where you want to be) to overinvolvement (excessive personal disclosure, secrecy, role reversal, touching, gestures, money or gifts, getting involved in patients’ personal affairs, sexual misconduct.

Defining professional boundaries comes down to the question of “Whose needs are you meeting?”

Term
different levels of anxiety and the related symptoms
Definition

1)      Mild anxiety-

(1)   Increased alertness

(2)   Ability to focus attention and concentrate

(3)   Produces an extended capacity for learning

2)      Moderate anxiety-

(1)   concentration is limited to one thing

(2)   increased body movement and rapid speech

(3)   subjective awareness of discomfort

3)      Severe Anxiety-

(1)   Scattered thoughts and difficulty with verbal communication

(2)   Subjective awareness of considerable discomfort

(3)   Purposeless movements- pacing and handwringing

4)      Panic-

(1)   Complete disorganization

(2)   Difficulty differentiating reality from imagination

(3)   Constant random movements

(4)   Unable to function without assistance

Term
Acute illness
Definition
involves a sudden onset of symptoms that progress quickly from mild to severe and subside quickly with or without treatment; partient usually returns to former level of functioning; changes are often not permanent but may progress to chronic illness; does not usually require long term behavioral change/treatment; may represent a life crisis
Term
 Chronic illness
Definition

 involves a gradual onset of symptoms that may be mild or vague; once the illness is resolved, there may be remissions and exacerbations; illness continues throughout the lifespan; changes are permanent and progressive; requires long term behavioral change/treatment; often represents a life crisis

Term
Family responses—the family experiences increased stress; family problems are seen as increasing/worsening with illness
Definition

(1)   Emotional responses:

(a)    Frightened

(b)   Resentful

(c)    Angry/guilty

(d)   Feelings of hopelessness

(e)    Distrust of healthcare providers;

(2)   Behavioral responses: critical and demanding behavior; withdrawal from the situation; confusions; deny seriousness of patient’s illness; promote dependence by patient

(3)   Caregiver stress—common in families of patients with prolonged, progressive illnesses, like dementia; is a role strain;

(a)    Symptoms-

(i)     Denial, anger, social withdrawal, anxiety, depression, sleeplessness, lack of concentration, health problems

Term

Model of Professional Socialization:

Brenner's Stages of Nursing Proficiency

(5 stages)

Definition
1. Novice- stud's entering nursing sch 2. Adv. Beginners- learners have become competent; can use theory/principles; not proficient 3. Competent Practitioner (2-3y)- begun to feel competent; organized & efficient most of time 4. Proficient Practitioners (3-5y)- begin to view pat's holistically; can recogn subtle changes; can focus on long-term goals 5. Expert Practitioners (extensive pract)- learners grasp pat. needs right away/autom; "sense" of what needs to be done based on experience
Term
How Americans Died
in the Past . .
Definition

Early 1900s
average life expectancy 50 years
childhood mortality high
adults lived into their 60s
Prior to antibiotics, people died quickly
infectious disease
accidents
Medicine focused on caring, comfort
Sick cared for at home
with cultural variations
Term
“American” Difficulties with Death
Definition

Urbanization
Segregation of the aged and dying
Movement towards the nuclear family
Secularization from religion
Advances in medical technology
Possibility of Mass Death
(i.e. nuclear war)
Term
Health Care’s Shift
Definition

Science, technology, communication

Marked shift in values, focus of North American society
“death denying”
value productivity, youth, independence
devalue age, family, interdependent caring
 Death “the enemy”
organizational promises
sense of failure if patient not saved
Term
Newman
Definition
Actual theory
Health with the absence of disease is not always possible
Stems from Roger's Unitary Human Beings
Consciousness is a manifestation of person-environment interaction
Term
Newman
Definition
Actual theory
Health with the absence of disease is not always possible
Stems from Roger's Unitary Human Beings
Consciousness is a manifestation of person-environment interaction
Term
Neuman
Definition
Model, not a theory
A person is layered and multidimensional
Layers represent levels of defense protecting the core being
Continuous feedback loops fine tune until maximum level achieved
Term
Metaparadigm of nursing
Definition
PERSON: layered and multidimensional being
ENVIRONMENT: internal, external, and created; stressors
HEALTH: health/wellness/expanding consciousness continuum
NURSING: levels of interventions to promote maximum wellness or level of consciousness
Term
King's Theory
Definition
describes a dynamic, interpersonal relationship in which a person grows and develops to attain certain life goals
Term
Johnson's Theory
Definition
Advocates the development of efficient and effective behavioral functioning in the patient in order to prevent illness
 
Johnson defines the patient as being a behavioral system
    - composed of 7 subsets which all require 3 things:
        *Protection from noxious influences
        *Provision for the nurturing environment
        *Stimulation for growth
 
Any imbalance in each system results in disequilibrium, it is the nurse's role to assist the patient to return to the state of equilibrium
Term
Watson
Definition
More holistic - as focused on patient’s emotional, spiritual, and mental needs
Nurse/client relationship
Term
Henderson
Definition
More focused on patient’s physical needs
Client gaining independence as soon as possible
Term
Leninger
Definition
3 C's
Culturally
Congruent
Care
Term
Estrin (Conservation)
Definition
Product of adaptation
The way in which complex systems are able to continue to function even when severely challenged
Individuals are able to confront many obstacles, adapt accordingly, and maintain their uniqueness
Goal = health and strength to confront disability
Nursing interventions may only deal with one particular conservation principle, but nurses recognize the influence of other conservation principles
Term
Outcomes vs goals
Definition
A nursing sensitive outcome
Outcome alone is patient response--good or bad
Expected outcome, predicted outcome, desired outcome, outcome criteria
Goal--broad statement about the desired result
Term
Planning
Definition
Problems needing individual plans
Choosing and adapting
Choosing outcomes and nursing orders
Initial vs On-going
Term
On-going
Definition
Beginning of each shift
Change in health status
Priorities
Problem to focus on during shift
Coordinate your activities address more than one problem at each client contact
Term
Discharge Planning
Definition
Make a written plan
Offer resources
Devise ways to increase compliance
Evaluate your teaching
Legal implications: Document
Term
Kinds of Discharge Planning
Definition
Standardized
Clinical paths
Computerized
Comprehensive
Nursing Dx Care Plan
Student Care plan
Term
Thinking critically about the content of diagnostic statements
Definition
Standards of reasoning
1. Clarity-statement is stated clearly and gives a clear statment of the patient;s situation
2.Clarity-the statement is concise (use NANDA labels)
3. Accuracy- the statement is accurate and valid
4. Precision- the statement is descriptive and specific ( know the label,add an etiology, PES fprmat, ad qualifying words;mild, moderate, intermittent)
5. Depth-The statement uses legally advisable language
6. Depth/Breadth- completel list of nursing diagnoses and collaborative problems reflects the clients overall health status
7. Breadth- The statement uses non-judgemental language
8. Logic- Cause and effect are correctly stated
9. Logic- The problem side fo the statement contains only one diagnostic label
10. The etiology is not merely a rewording of the problem-At least one side of the statement providesdirection for nursing actions.

5.
Term
Collaborative Problem
Definition
Certain physiological complications that nurses monitor for in order to prevent or minimize complications.
Complications are related to diseases
Term
Thinking critically about interventions
Definition
Nurses use therapeutic judgement to determine which interventions are most likely to achieve the desired outcomes.
Term
LEARN
Definition
May assist in mediating and collaborating regarding interventions for patients

Listen to others
Explain your perceptions
Acknowledge and discuss differences
Recommend alternatives
Negotiate agreement
Term
problem-oriented medical record (POMR)
Definition
method of recording data about the health status of a patient in a problem-solving system. Preserves the data in an easily accessible way that encourages ongoing assessment and revision of the health care plan by all members of the health care team.A data base is collected before beginning the process of identifying the patient's problems. The data base consists of all information available that contributes to this end, such as that collected in an interview with the patient and family or others, that from a health assessment or physical examination of the patient, and that from various laboratory and radiologic tests. It is recommended that the data base be as complete as possible, limited only by potential hazard, pain or discomfort to the patient, or excessive assumed expense of the diagnostic procedure.
Term
SOAP charting and each component
Definition
Each SOAP note refers to a specific problem; multiple problems require multiple notes
S- Subjective (what the patient tells you
O-Objective; information that you measure or observe
A-Assessment; interpretation or explanation for the "S" and the "O" data. Describes a patient;s condition and progress toward goals.
P-Plan; care plan to resolve the problem. The plan is updated or discontinued in subsequent SOAP notes.
Term
DAR and each component
Definition
Called Focus charting, uses key words to label and organize the progress notes, but the subject of the note is not necessarily a problem.
D-Data; observation of patient status and behaviors. Might include data from flow sheets. Includes both subjective and objective data and corresponds to the assessment phase of the nursing process.
A-Action; includes interventions performed as well as plans for further action. Corresponds to the planning and implementing steps of the nursing process.
R-response;describes the patient's responses to nursing interventions. Data in this section consists of measurements and interventions which may be recorded on flowsheets, and checklists. This section corresponds to the evaluation phase of the nursing process.
Term
Purpose of medical record
Definition
Provides communication between healthcare professionals who interact with a client, helping to prevent fragmentation, repetition, and delays in client care. Also referred to by health team members in planning care.
Term
Preparing the nurse
Definition
Prior to beginning an intervention, review care plan to clarify any details and determine if you need help in performing any of the interventions. Assistance may be required when:
1. You lack the skill or knowledge to implement a nursing order
2. YOu cannot safely perform the action alone
3. Assistance would reduce the client's stress.
Term
Preparing the patient
Definition
Before implementing, reassess whether the intervention is still needed. Assess the client's readiness by observing client behavior cues. Explain to the client what is to take place.
Term
Preparing supplies and equipment
Definition
Assemble all supplies and equipment before entering the room so that you may proceed efficiently and with a minimum amount of stress to the patient.
Term
Dependent interventions
Definition
performed when following primary care provider's orders or agency policies.
Term
Collaborative (interdependent) interventions
Definition
are performed either with other health professionals or as a result of decisions made jointly with them.
Term
Coordination of care
Definition
involves scheduling teh client's contacts with other hospital departments and serving as a liaison among the members of the healthcare team.
Term
Independent (autonomous) interventions
Definition
performed when carrying out the nursing orders and often in conjunction with the medical orders. In addition to legally conferred autonomy, the nurse's knowledge and critical thinking determine the degree to which an action can be considered autonomous.
Term
Accountability
Definition
an aspect of autonomy where the nurse is answerable for their actions and can define, explain, and evaluate the results of their decisions.
Term
Delegation
Definition
the transfer of responsibility for the performance of a taskor activity from one person to another while retaining accountability for the outcome. This includes assigning the right activities to the right person. You must know the person's knowledge, skills, abilities, motivation, background and experience.
Term
Potential Nursing DX (at risk for)
Definition
Diagnosed by risk factors that predispose patient/client to the dx.
Used only for patients who have a higher than normal risk for developing problem.
Risk for constipation
Risk for trauma
Risk for volume deficit
Term
Actual Nursing DX
Definition
PES Statement
Problem
Etiology (related to)
Signs and symptoms (defining characteristics)
Term
Components of goal statement
Definition
Subject
Verb
Conditions
Criteria
Target time
Term
Expected outcomes
Definition
Guides for planning and evaluation
Stated in specific, observable, achievable patient behaviors
Consists of subject, action verb, performance criteria, target time, and special conditions
Individuals, families, or groups
Culturally sensitive
Term

 

Patient’s Voice Notes
Get Em Out of the Shed
Definition

 

“Many of the people I met in the course of my peripatetic journey down pain alley, not to mention home care, were efficient enough. I suppose.  I didn’t die or go into convulsions. But a warm human touch was missing.”
Term

 

Mastery of Life
4 Principles
Definition

 

1 As the person with the greatest stake in my health care, I make the decisions and no health professional can overrule my preferences 
2 As I am the only legitimate decision maker, no one else is permitted to speak for me.
3.   I must have complete information about myself.
4. Healthcare is a means to a full and meaningful life; it is not an end in itself.
Term

 

What is Differentiated practice?
Definition

 

Other Settings for nurses
Non-traditional practice settings
Nurse entrepreneurship
Nurse managed clinics/school nurses
Term

 

Impact of Health Care Changes on Nursing
Definition
Change in place of employment
Cost containment
Skill mix and safe delegation
Autonomy and accountability
Shared governance
Patient outcomes
Technology
Information systems
Genetic engineering
Ethics
Term

 

"optimism in the face of tragedy and in view of the human potential which at its best always allows for:
Definition

 

(1) turning suffering into a human achievement and accomplishment;
    (2) deriving from guilt the opportunity to change oneself for the better;
    (3) deriving from life's transitoriness an incentive to take responsible action."
Term

 

American difficulties with death arise from:
Definition

 

Urbanization
Segregation of the aged and dying
Movement towards the nuclear family
Secularization from religion
Advances in medical technology
Possibility of Mass Death
(i.e. nuclear war)
Term

 

The three leading causes of death in adult Americans:
Definition

 

Cardiovascular disease
 
Cancer
 
Cerebrovacular diseases
Term
2 most common fears with death and dying
Definition

1. Dying in pain

2. Being a burden

Term

 

Standards for Hospice and Palliative Care
Definition

 Access to care, delivery of care

Informed choices
Symptom management
Psychological, social and spiritual support
 Grief, bereavement support
Continuity between care settings
Evaluation, research, education
Term

 

Procedures of Informed Consent
Definition

 

Documentation
Process of deliberation
Shared decision making
Communication of news
Physicians have direct responsibility
Term

 

POLST
Definition

 

Physician Orders for Life-Sustaining Treatment Guidance for Health Care Providers
Communication of patient wishes to:
Primary care physicians
 Nurse practitioners
Long-term care facilities
Hospices
Home health agencies
Emergency physicians
NOTE: POLST is NOT an Advance Directive and DOES NOT replace the patient’s advance directive.
Emergency medical services
Term
POLST
Definition

Part A
 Resuscitation
Part B
 Medical Interventions
 Part C
 Antibiotics
Part D
 Artificially Administered Fluids and Nutrition
Part E
 Discussed With patient
 Part F
Guide
Term
Advance care planning
Definition
process of discussion, documentation, implementation
Term

 

Advance directives
Definition

instructional statement

living will
values history
personal letter
medical directive
Term

The Patient's Voice

"Art Life and Psychosis"

Definition
A therapist assists a bi polar patient in recognizing personal meaning in psychotic episodes. Patient experiences impersonal treatment by emergency room staff, and a psychiatrist- no explanation of disorder or treatment. Patient experiences change with a psychiatrist who takes time to explain bout patients illness, medications etc... "It is important to allow individuals to explore their own experiences in order to facilitate finding meaning within them. Also explained in the story was the taboo and stereotypes of mentally ill patients and the fact that the author still hides from creative expression.
Term

The Patient's Voice

 

"Get the Money"

Definition

POV is a lawayer who takes a case of a 19 y/o boy sho is paralyzed after making a judgement error and diving into the shallow end of a pool and breaking his 5th cervical vertibra.

Two years after injury, the lawyer is contacted by the boy who is now interested in legal action against condominium ownership. Lawyer explains that the patient with major injuries goes through stages that in many cases result in effective coping and making the best of a situation. The theme also introduces the idea of an increase group: an increase group is a "...closed group engaged in rhythmic, stylized activities to bring about prosperity. These activities continue until the objective is achieved. Ex: Native American (First Nation) participating in a rain dance until it rains. Also Health Care Providers working together on a patient to affect a positive outcome- until the outcome can be explored by the court system in which case, the patient becomes part of the process of the increase group. 

Term

The Patient's Voice

" Get 'em Out of the Shed"

Definition
 An elderly man recalls his experiences of being ill over several years. His treatment by health care providers and workers is comparable to that of the providers portrayed in the "Wit" Ex: he goes to the hospital to have surgery and the Dr. is late and do he has to wait overnight only to be taken into surgery with out explanation or consnet. He subsequently discharged and is taken home by two non-english speaking drivers to his second floor apartment. WIth a walker (or crutches) to negotiate the stairs. He is later visited by various nurses who change his dressings. Ultimately, he finds that a nurse who is deaf provides him with the most effective care.
Term

The Patient's Voice

"Mastery of LIfe"

Macurdy's 4 Principles

Definition

1. I make decisions regarding my health and no helath care professional can override my preferences

2. I am the highest decision maker- no one else is permitted to speak for me

3. I must be given complete information regarding my health care

4. Health care is a means to a full and meaningful life and is not an end in itself

Term

Interviews

(Assessment)

Definition

                                                           i.      Nondirective- patient controlled

1.      The nurse clarifies, summarizes, uses open ended questions and comments to encourage communication

                                                            ii.      Directive- highly structured

1.      The nurse uses closed questions in order to control subject matter and obtain specific information

a.      Used to obtain factual information that is easy to categorize, like age, sex, and analysis of symptoms

Term

Open-ended questions

Definition

May specify the topic of discussion, but is broad and requires elaboration from the patient

 EX. Tell me about your accident; describe your pain to me; what were your thoughts/feelings when you found out you were pregnant

Used to guide the pt’s talk about other topics, like sleep patterns, pain, and usual routines

Term

Closed questions

Definition

1. Require only “yes” or “no,” or short factual answers giving specific information

2.      Often begin with “when,” “where,” “who,” “what,” “do,” “is,” and sometimes “how”

3.      Used to obtain the more specific information in nursing history. And in follow-up, after broad questions have been asked

4.      When was your accident? Are you in pain? Was this a planned pregnancy?

Term

Frameworks

Definition
tell you what to assess and why—by clustering
Term

Gordon

Definition

     Common behavior patterns that contribute to health, quality of life, and achievement of human potential;

                                                            ii.      Using this framework, you note emerging patterns and determine if patient’s functioning in each pattern is functional or dysfunctional.

                                                          iii.      Health-perception/health management

1.      Describes clients perception of health and well-being and how health is managed

Term

Gordon's Framework

Nutritional/metabolic

Definition
Pattern of food and fluid intake relative to metabolic need indicators of local nutrient supply a. Ex. Condition of skin, teeth, hair, nails, mucous membranes; height and weight; fluid and electrolyte balance
Term
Formulating Nursing Diagnosis
Definition
a. Use of diagnostic reasoning to analyze data and draw conclusions about the client’s health statues; then, verify these conclusions with the client, select standardize labels, and record them on the plan of care. b. Assessment phase affects the diagnostic phase, as the quality of data collected during the assessment is used to formulate diagnosis; the two phases also are integrated, as the nurse is normally doing the diagnosis phase (parts of it) in the assessment phase
Term

ACTUAL DIAGNOSIS FORMULATION—the nurse:

                                                      

Definition

        i.      Derives the diagnosis or issues based on assessment data

                                                            ii.      Validates the diagnoses or issues with the patient, family, and other healthcare providers when possible or appropriate

                                                          iii.      Documents diagnoses or issues in a manner that facilitates the determination of the expected outcomes and plans

Term

Diagnoses are based on?

Definition

 human response

                                                              i.      Responses to a stressor can be helpful or harmful

                                                            ii.      Biological: Pain

1.      Cellular- occurs at a level of individual cells (the ability of a cell to use glucose may change)

2.      Systemic- responses occur in body systems (peripheral vasodilation, increased respiratory rate) – used for diagnosis

3.      Organic- localized skeletal muscle fatigue

                                                          iii.      Psychological: Fear of dying

                                                           iv.      Interpersonal/social dimensional: returning to work before full recovery

                                                             v.      Spiritual dimension: praying

Term

Wellness diagnosis-

Definition

a.      Describes areas where a healthy client is functioning normally- there is no problem, but the person wants to achieve a higher state of wellness

b.      Definition: a statement reflecting a client’s healthy responses in areas where the nurse can intervene to promote growth or maintenance of the healthy response

Term

 Actual diagnosis:

Definition

a problem that is actually present at the time you make the assessment

Recognized by the presence of associated signs and symptoms (defining characteristics)

Term

Possible diagnosis:

Definition

a problem that you tentatively believe exists

                                          i.      Is similar to what a physician’s “rule out” diagnosis

ii.      A possible problem directs nursing care toward gathering focus data to confirm or eliminate the diagnosis

Term

a.      Potential diagnosis:

Definition

a problem that is likely to develop if nurse does not intervene

i.      Diagnosed by presence of predisposing risk factors

ii.      Nursing care is directed toward preventing the problem by reducing the risk factors, or toward early detection of the problem to lessen its consequences

Term

Collaborative problems:

Definition

potential complications of medical treatment or surgery

a.      Definitive treatment of the condition requires both medical and nursing interventions

b.      Independent nursing interventions for collaborative problems focus on monitoring for and minimizing complications

c.       The same collaborative problems tend to be the same every time a diseases/treatment is present

Term

Medical problems:

Definition

 identifies a disease process

a.      Made for the purpose of treating the pathology

b.      Unlike a nursing diagnosis, it does not consider the human response to the pathology

c.       As long as the disease process is present, medical diagnosis does not change; nursing diagnoses, however, change as the client’s responses change

Term

 

 Overview of Diagnostic Reasoning

 

Definition

a.      Interpret the data

                                                  i.      Identify significant cues

1.      Organize data using a framework, and compare individual data to standards and norms to identify significant cues

                                                ii.      Cluster cues and identify data gaps

1.      Cluster significant cues, looking for patterns and relationships

2.      Categorize clusters according to framework

3.      Identify gaps and inconsistencies

                                              iii.      Draw conclusions about present health status

1.      Think of as many explanations as possible for each cue cluster.

2.      Identify problem (wellness diagnosis; nursing diagnosis, collaborative problems; medical problems

3.      Identify patient and family strengths

                                               iv.      Determine etiologies and categorize problems

1.      Determine causes of the problems

a.      Physiological, psychological, sociological, spiritual, or environmental factors

2.      Categorize problems according to the framework used

a.      In this step, you are categorizing the problem, not the etiology. When you write the formal diagnosis, you first look at the diagnostic labels in the category (nutritional/metabolic) pattern.

                                                 v.      Verify the diagnosis

1.      Verify diagnosis and strengths with patient, family, other professionals, and references

                                               vi.      Label the diagnosis

1.      Choose standardized problem label.

a.      Write formal health status statements

2.      Prioritize the problems

                                             vii.      Record the data

1.      Record the problem statements on the appropriate documents: patient care plan, chart, etc.

Term

Confidentiality

                                                            

Definition

  i.      Also affects autonomy—because a breech in confidentiality goes against how you told the pt the information would be used

                                                            ii.      When the pt tells you something in confidence that you feel you must tell in order to protect them

1.      There needs to be a balance b/t pt autonomy and the need to protect the client/others

Term

Malpractice suits—monitoring is important

                                                            

Definition

  i.      Failure to monitor is a common cause of lawsuits

1.      Monitoring is a frequent, ongoing assessment ofent done at specified intervals.

2.      Sometimes ordered by a physician, but may be ordered by a nurse

3.      Don’t forget to document monitoring!!!

a.      Categorize problems according to the framework used

Term

Prioritizing diagnosis (p. 241)

Definition

a.      Sometimes a part of the planning phase, but if the diagnoses are to be recorded in priority order, then prioritizing must be done in the diagnosis phase.

                                                              i.      Consider risk problems when setting priorities. May be as important to prevent a problem, as it is to treat an actual one.

Term

 Preservation of life as a criterion

Definition

rank diagnoses based on the amount of threat they pose to the client’s life

                                                              i.      High-priority problems

1.      Life-threatening (severe electrolyte loss or respiratory obstruction)

                                                            ii.      Medium-priority problem

1.      Does not pose a direct threat on life, but may produce destructive physical or emotional changes (Rape-Trauma Syndrome)

                                                          iii.      Low-priority problem

1.      One that arises from normal developmental needs, or requires only minimal supportive nursing intervention

Term

Maslow’s Hierarchy of Needs/Kalish Priorities

                                                         

Definition

     i.      Survival needs- food, air, water, temperature, elimination, rest, pain avoidance

                                                            ii.      Stimulation needs

1.      Sex, activity, exploration, manipulation, novelty

                                                          iii.      Esteem needs

Term

Patient preference

                                                      

Definition

        i.      Balance pt preferences with therapeutic and safety needs

                                                            ii.      This increases the likelihood that the problems will be resolved; patients will cooperate more enthusiastically to solve problems they feel are impt.

Term

Types of Planning

Definition

a.      Formal Planning- a conscious, deliberate activity involving decision making, critical thinking, and creativity

b.      Time-sequenced planning

                                                              i.      When planning a pts care for a shift or 24-hour period

c.       Initial planning

                                                              i.      Begins with first pt contact and continues until the nurse-patient relationship has ended, usually when the pt has been discharged.

d.      Ongoing planning

                                                              i.      Done by any nurse who works with the pt

                                                            ii.      Carried out as new info is obtained and as the client’s responses to care are evaluated.

                                                          iii.      Also occurs as planning is done at the beginning of the day in order to:

1.      Determine whether the client’s health status has changed

2.      Set the day’s priorities for the client’s care

3.      Decide which problems to focus on during the shift

4.      Coordinate activities so that you can address more than one problem at each client contact

e.      Multidisciplinary plans of care (critical pathways)

                                                              i.      Plan of care that sequences patient care based on diagnosis or case type

                                                            ii.      Best work for cases that occur frequently in an agency or that have relatively preventable predictable outcomes.

                                                          iii.      Does not take the INDIVIDUAL patient into account

1.      Variance occurs when an outcome is not met in the specific time

2.      Intervention is not performed at the specified time

 

 

Term

Goals vs Outcomes

 

Definition

NOC— outcome = any pt response (good or bad) to interventions

a.

     

     

Goals and desired outcomes = predicted outcomes, expected outcomes, outcome criteria

b.      Goals are much broader than outcomes. Outcomes are the more specific, observable criteria used to evaluate whether the broad goal has been met

Term

Purpose of Outcome Statement

Definition

                                                              i.      Guide the planning of care and the evaluation of changes in pt health status

                                                            ii.      Provides a sense of accomplishment for both the client and the nurse; motivates them in their efforts to improve health status

Term
Short term vs. long term goals
Definition

                                                              i.      Short-term- can be achieved within a few days or a few hours

1.      Goals dealing with survival needs may be short term

a.      Common for pain med effectiveness, voiding after surgery, ambulation post-op

2.      Can be used to measure progress toward long term goals

a.      As achievement provides reinforcement for the client

                                                            ii.      Long-term goals- describe changes in client outcomes over a long period (usually a week or more)

1.      Aims at restoring normal functioning in the problem area

2.      When the normal level cannot be achieved, a maximum level of functioning is planned for, given the client’s health status and resources

a.      Useful for clients with long-term or chronic health problems; clients in home health care, rehab centers, and other extended-care facilities

Term
Every goal statement (expected outcome) should contain
Definition

1.      Target time

2.      Action verb

3.      Performance criteria

4.      Subject

Term

Nursing Outcomes Classification

Definition

a.      Nurse chooses outcomes listed in NOC taxonomy based on the nursing diagnoses that have been identified

                                                              i.      Indicators are concrete, observable, behaviors and states that can be used to evaluate pt status.

                                                            ii.      Each outcome has a list of indicators; nurse selects the indicators that are appropriate for the pt

1.      A 5 point measurement scale is used to evaluate pt’s status on each indicator

                                                          iii.      Not necessary to state desired outcomes when using this system

1.      You just rate the pt’s status on each indicator before and after interventions

Term

a.      CCC.- clinical care classification

                                        

Definition

                      i.      3 modifiers are used:

1.      Improved, stabilized, and deteriorated

2.      Nurse uses these to create an outcome goal for each nursing diagnosis

                                                            ii.      This is not useful in testing effectiveness of nursing interventions

1.      Is designed for home healthcare

Term

Goals/outcomes for Wellness Diagnoses

                                                            

Definition

  i.      Describe client responses that demonstrate health maintenance or achievement of a higher functioning level

                                                            ii.      Both Omaha and NOC systems may be used

                                                          iii.      Goals are set based on client potentials

Term

a.      PIE and PART charting

                                                         

Definition

PIE

1.      Problems

2.      Interventions

3.      Evaluation

a.      This system supplements pt progress notes with a flow sheet for assessments and routine care

b.      Nurse rewrites and renumbers it ever 24 hrs

                                           PART

1.      This method makes use of standards of care

2.      The problem list is seen as ongoing, so it is not rewritten every day

3.      The nurse records all actual interventions in the chart

a.      P- problem

b.      A- actions

                                                                                                                                      i.      All interventions actually implemented

                                                                                                                                    ii.      Does not contain care plan

c.       R- response

                                                                                                                                      i.      Actual patient outcomes

                                                                                                                                    ii.      Subj. and obj. data describing pt. responses to the actions/interventions

d.      T-teaching

                                                                                                                                      i.      Patient and family teaching

                                                                                                                                    ii.      Meant to remind care providers of the impt of this aspect of care

Term

Focus Charting

Definition

1.      A focus may be a condition, strength, nursing diagnosis, behavior, sign/sympt, significant change in pt condition

2.      The problem should not be a medical diagnosis

a.      It can describe the needs and conditions assoc. with a med. diagnosis.

3.      Useful for health promo activities because nurse can organize around positive headings rather than problems

Term

D-A-R

Definition

a.      Data

                                                                                                                                      i.      Patient’s status and behaviors

1.      Data from flowsheets (vital signs)

2.      Includes both subj. and obj. data

3.      This section corresponds w/ assessment phase of the nursing process

b.      Action

                                                                                                                                      i.      Interventions just performed

                                                                                                                                    ii.      Plans for further action

                                                                                                                                  iii.      Corresponds with planning/implementation of the nursing process

c.       Response

                                                                                                                                      i.      Pt. responses to nursing and medical interventions

                                                                                                                                    ii.      Data consists of measurements and interventions

1.      May be recorded on flowsheets/checklists

                                                                                                                                  iii.      Corresponds w/ evaluation phase of nurs. process

Term

Charting by Exception (CBE)

Definition

1.      Only significant findings or exceptions are recorded

2.      Standardized identification of

a.      Norms for pt assessments

b.      Minimum criteria for pt care

3.      EX. “the patient will receive or be offered oral care t.i.d.”

a.      “The pt will receive or offered a bed bath and back rub daily, and a shampoo once a week

Term

The medical record…

Definition

a.      Serves as a legal document for recording all client activities by health care practitioners.

                                                              i.      Professional Responsibility and Accountability

                                                            ii.      Communication

                                                          iii.      Education

                                                           iv.      Research

                                                             v.      Legal and Practice Standards

Term

POMR

Definition

a.      Uses flow sheets to record routine care.

b.      A discharge summary addresses each problem.

c.       SOAP entries are usually made at least every 24 hours on any unresolved problem.

d.      SOAP was developed on a medical model.

Term

Kardex—

Definition
used as a reference throughout the shift and during hand-off reports (change-of-shift)
Term

Nurse’s progress notes

Definition

used to document the client’s condition, problems and complaints, interventions, responses, achievement of outcomes.

b.      can be completely narrative or incorporated into a standardized flow sheet.

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