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299 Cards in this Set

  • Front
  • Back
Define Critical Thinking
Critical thinking is judgment that includes critical and reflective thinking and action and application of scientific and practical logic.
Critical thinking is an active, organized, cognitive process used to carefully examine one's thinking and the thinking of others. It involves recognizing that an issue (e.g., client problem) exists, analyzing information about the issue (e.g., clinical data about a client), evaluating information (reviewing assumptions and evidence) and making conclusions
What is evidence-based knowledge?
knowledge based on research or clinical expertise, makes you an informed critical thinker.
Critical thinking requires not only cognitive skills but also…
to ask questions, to remain well informed, to be honest in facing personal biases, and to always be willing to reconsider and think clearly about issues.
Nurses who apply critical thinking in their work focus on…
options for solving problems and making decisions, rather than quickly and carelessly forming quick solutions.
Reflection is
the process of purposefully thinking back or recalling a situation to discover its purpose or meaning.
Confidence
Learn how to introduce yourself to a client; speak with conviction when you begin a treatment or procedure. Do not lead a client to think that you are unable to perform care safely. Always be well prepared before performing a nursing activity. Encourage a client to ask questions.
Thinking independently
Read the nursing literature, especially when there are different views on the same subject. Talk with other nurses and share ideas about nursing interventions.
Fairness
Listen to both sides in any discussion. If a client or family member complains about a co-worker, listen to the story and then speak with the co-worker as well. If a staff member labels a client uncooperative, assume the care of that client with openness and a desire to meet that client's needs.
Responsibility and authority
Ask for help if you are uncertain about how to perform a nursing skill. Refer to a policy and procedure manual to review steps of a skill. Report any problems immediately. Follow standards of practice in your care.
Risk taking
If your knowledge causes you to question a health care provider's order, do so. Be willing to recommend alternative approaches to nursing care when colleagues are having little success with clients.
Discipline
Be thorough in whatever you do. Use known scientific and practice-based criteria for activities such as assessment and evaluation. Take time to be thorough, and manage your time effectively.
Perseverance
Be cautious of an easy answer. If co-workers give you information about a client and some fact seems to be missing, go clarify information or talk to the client directly. If problems of the same type continue to occur on a nursing division, bring co-workers together, look for a pattern, and find a solution.
Creativity
Look for different approaches if interventions are not working for a client. For example, a client in pain may need a different positioning or distraction technique. When appropriate, involve the client's family in adapting your approaches to care methods used at home.
Curiosity
Always ask why. A clinical sign or symptom often indicates a variety of problems. Explore and learn more about the client so as to make appropriate clinical judgments.
Integrity
Recognize when your opinions conflict with those of a client; review your position, and decide how best to proceed to reach outcomes that will satisfy everyone. Do not compromise nursing standards or honesty in delivering nursing care.
Humility
Recognize when you need more information to make a decision. When you are new to a clinical division, ask for an orientation to the area. Ask registered nurses (RNs) regularly assigned to the area for assistance with approaches to care.
Professional standards for critical thinking
refer to ethical criteria for nursing judgments, evidence-based criteria used for evaluation, and criteria for professional responsibility.
Ethical criteria
Being able to focus on a client's values and beliefs helps you to make clinical decisions that are just, faithful to the client's choices, and beneficial to the client's well-being. Critical thinkers maintain a sense of self-awareness through conscious awareness of their beliefs, values, feelings, and the multiple perspectives that clients, family members, and peers present in clinical situations.
Evidence-based criteria
These criteria are sometimes scientifically based on research findings or practice based on standards developed by clinical experts and an institution's quality improvement initiatives.
Criteria for professional responsibility
The standards of professional responsibility that a nurse tries to achieve are those standards cited in Nurse Practice Acts, institutional practice guidelines, and professional organizations' standards of practice. The American Nurses Association Standards of Professional Performance (see Chapter 1) is an example. These standards “raise the bar” for the responsibilities and accountabilities that a nurse assumes in guaranteeing quality health care to the public.
Clinical learning experiences are necessary to what?
Acquire clinical decision-making skills. Clinical experience is the laboratory for testing your nursing knowledge.
- Assessment
the deliberate and systematic collection of data to determine a client’s current and past health status and functional status and to determine the client’s present and past coping patterns
1.Collection and verification of data from a primary source (client) and secondary sources (family, medical record, etc.)
2. Analysis of all data as a basis for developing nursing diagnoses, identifying collaborative problems, and developing a plan of individualized care
- Diagnosis
a clinical judgment about the patient’s response to a stressor which may lead to potential or actual health problems
-Diagnoses are formulated and validated with the patient, family, and other health care providers when possible and appropriate
-They are documented and provide the platform for identification of the expected outcomes and the plan of care
- Outcome Identification
the nurse identifies expected outcomes individualized to the patients
-Based on the problem clause of the nursing diagnosis
-Outcome is a specific measurable criterion which contains a time limit regarding a change in behavior or health status
- Planning
the nurse sets client centered goals and expected outcomes and plans nursing interventions
-Should be individualized to the patient
- Implementation
the nurse implements the interventions identified in the plan of care
-Once you have performed the actions, document it.
- Evaluation
it’s crucial to determine whether the client’s condition or well-being improves
-Conduct evaluative measures to determine if you met expected outcomes
-Document whether the criterion was met
- Diagnosis
a clinical judgment about the patient’s response to a stressor which may lead to potential or actual health problems
-Diagnoses are formulated and validated with the patient, family, and other health care providers when possible and appropriate
-They are documented and provide the platform for identification of the expected outcomes and the plan of care
- Outcome Identification
the nurse identifies expected outcomes individualized to the patients
-Based on the problem clause of the nursing diagnosis
-Outcome is a specific measurable criterion which contains a time limit regarding a change in behavior or health status
- Planning
the nurse sets client centered goals and expected outcomes and plans nursing interventions-Should be individualized to the patient
- Implementation
the nurse implements the interventions identified in the plan of care-Once you have performed the actions, document it.
- Evaluation
it’s crucial to determine whether the client’s condition or well-being improves
-Conduct evaluative measures to determine if you met expected outcomes
-Document whether the criterion was met
Cite the ANA Standard I criteria for assessment
-Data collection involves the patient, family, and other health care providers as appropriate
-The priority of data collection activities is determined by the patient’s immediate condition or needs
-Pertinent data are collected using appropriate assessment techniques and instruments-Relevant data are documented in a retrievable form
-The data collection process is systematic and ongoing
List the areas which are included in the patient assessment
-Reason for hospitalization
-Patient history
-Present surgery, procedures, significant events, or complications
-Vital signs
-Neurological assessment
-Cardiovascular assessment
-Respiratory assessment
-Gastrointestinal assessment
-Urinary assessment
-Musculoskeletal assessment
-Integumentary assessment
-Immune assessment
-Psycho-social, spiritual assessment
-Medication
- Stressor
– any factor which causes stress to the patient and disturbs the body’s equilibrium
- Stress response
– a symptom cause by a stressor
Cite the ANA Standard II Criteria for Diagnosis
Diagnoses are derived from the assessment data
Define NANDA (North American Nursing Diagnosis Association)
A professional nursing association formed with the purpose of creating and standardizing nursing diagnoses
-Provides nurses with their own vocabulary
Create a three part nursing diagnosis
-Problem – Chosen from the NANDA list, describe the response to stressors
-Etiology – Stressors related to, or causing the problem
-Defining Characteristics – Response to stressor or the patient’s actual signs and symptoms
Define “outcome” criteria
An outcome is a specific measurable criterion which contains a time limit regarding a change in behavior or health status
-Based on the problem clause of the of the nursing diagnosis
-Can be easily evaluated because they are so specific-There must be at least one outcome for every nursing diagnosis
Cite the ANA standard III regarding outcome criteria
-Outcomes are derived from the diagnoses-Outcome is mutually formulated with the patient, family, and other healthcare providers when possible and appropriate-Outcomes are culturally appropriate and realistic in relation to the patient’s present and potential capabilities-Outcomes are attainable in relation to resources available to the patient-Outcomes include a time estimate for attainment-Outcomes provide direction for continuity of care-Outcomes are documented as measurable goals
Evaluate the outcome criteria to ensure that it is
-Patient centered
-Reasonable
-Attainable
-Measurable
-Time-driven
Cite the ANA standard IV regarding planning
-The plan is individualized to the patient (e.g. – age appropriate, culturally sensitive) and the patient’s condition or needs
-The plan is developed with the patient, family, and other healthcare providers as appropriate
-The plan reflects current nursing practice
-The plan provides for continuity of care
-Priorities for care are established
-The plan is well documented
Cite the ANA Standard V regarding implementation
-Interventions are consistent with the established plan of care
-Interventions are implemented in safe, timely, and appropriate manner
-Interventions are documented
Cite the ANA Stanard VI regarding evaluation
-Evaluation is systematic, ongoing and criterion based
-The patient, family, and other healthcare providers are involved in the evaluation process as appropriate
-Ongoing assessment data are used to revise diagnosis, outcomes, and the plan of care as needed
-Revisions in diagnoses, outcomes, and the plan of care are documented
-The effectiveness of interventions is evaluated in relation to outcomes
-The patient’s responses to interventions are documented
ANA defines nursing as
the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
How is Nursing is an art and science?
Nursing as a science is based on a body of knowledge that is continually changing with new discoveries and innovations.
Nurse Practice Acts
establish specific legal regulations for practice, and professional organizations establish standards of practice as criteria for nursing care.
The ANA
is concerned with legal aspects of nursing practice, public recognition of the significance of nursing practice to health care, and implications for nursing practice regarding trends in health care. Nursing protects, promotes, and optimizes our clients' health, prevents illness and injury, alleviates suffering through the diagnosis and treatment of human responses, and advocates for the care of our clients.
• 1.Assessment
The registered nurse collects comprehensive data pertinent to the patient's health or the situation.
• 2.Diagnosis
The registered nurse analyzes the assessment data to determine the diagnoses or issues.
• 3.Outcomes Identification
The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation.
• 4.Planning
The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.
• 5.Implementation
The registered nurse implements the identified plan.
• 6.Evaluation
The registered nurse evaluates progress toward attainment of outcomes.
• 7.Quality of Practice
The registered nurse systematically enhances the quality and effectiveness of nursing practice.
• 8.Education
The registered nurse attains knowledge and competency that reflects current nursing practice.
• 9.Professional Practice Evaluation
The registered nurse evaluates one's own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.
• 10.Collegiality
The registered nurse interacts with and contributes to the professional development of peers and colleagues.
• 11.Collaboration
The registered nurse collaborates with patient, family, and others in the conduct of nursing practice.
• 12.Ethics
The registered nurse integrates ethical provisions in all areas of practice.
• 13.Research
The registered nurse integrates research findings into practice.
• 14.Resource Utilization
The registered nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services.
• 15.Leadership
The registered nurse provides leadership in the professional practice setting and the profession.
As a caregiver:
you help the client regain health and a maximal level of independent function through the healing process. Healing involves more than achieving improved physical well-being. You need to meet all health care needs of the client, including measures to restore emotional, spiritual, and social well-being. As a caregiver, you help the client and family set goals and assist them with meeting these goals with minimal financial cost, time, and energy.
As a client advocate you:
protect your client's human and legal rights and provide assistance in asserting those rights if the need arises. For example, you may provide additional information to help a client decide whether or not to accept a treatment, or you find an interpreter to help family members communicate their concerns. You may sometimes need to defend clients' rights in a general way by speaking out against policies or actions that put clients in danger or conflict with their rights. In advocating for the client, you need to be aware of the client's religion and culture.
Communicator
Communication is central to the nurse-client relationship. The nurse-client relationship helps you to know your clients, their strengths and weaknesses, their needs, and their fears. Communication is essential for all nursing roles and activities. You will routinely communicate with clients and families, other nurses and health care professionals, resource persons, and the community. Without clear communication, it is impossible to give comfort and emotional support, give care effectively, make decisions with clients and families, protect clients from threats to well-being, coordinate and manage client care, assist the client in rehabilitation, or provide client education. The quality of communication is a critical factor in meeting the needs of individuals, families, and communities.
Manager
Today's health care environment is fast paced and complex; managers need to establish an environment for collaborative care to provide quality care and good client outcomes. A manager coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency. The manager performs many activities, which may include helping to establish and evaluate performance goals for the unit, monitoring professional nursing standards of practice, recruiting and hiring new employees, determining the staff development and continuing education needs, and evaluating employees. A manager also establishes and implements quality improvement plans for the unit.
Career Opportunities of Nurses
Clinical Practice, education, research, management, administration, Advance Practice, Clinical Nurse Specialists, Nurse Practitioner, Certified Nurse Midwife, Certified registered Nurse Anesthetist.
a) Specialized knowledge
requires extended education with a basic liberal foundation.
b) Body of knowledge
theoretical body of knowledge leading to defined skills, abilities and norms.
c) Service orientation
to care for others.
d) Ongoing research
continuing to investigate. To come up with research topics to improve patient care.
e) Code of ethics
philosophical ideals of right and wrong that define the principles you will use to provide care to your clients.
f) Autonomy
being able to direct ourselves. Ability to make decisions in practice. The essential element of professional nursing. Making decisions to implement coughing and deep breathing exercises for a new postoperative patient. Nursing without constantly asking what to do next from others.
NLN
The NLN sets standards for excellence and innovation in nursing education.
ANA
The ANA’s purpose is to improve standards of health and the availability of health care to foster high standards for nursing, to improve the professional development and general and economic welfare of nurses.
ICN
The ANA is part of the ICN. The objectives of the ICN are parallel to those of the ANA
NSNA
The NSNA considers issues of importance to nursing students, such as career development and preparation for licensure.
State Board of Nursing-Regulates licensure.
Nurse Practice Acts defines the scope of practice.
F. Factors that Facilitate the socialization process
You are being professionalized- you are assimilating the values, knowledge, and attitudes of a professional nurse
Societal influences on nursing
Demographic changes-Woman’s health care issues-Human rights-Medically underserved-Threat of bioterrorism
1. Define the meaning of theory
A theory is a set of concepts, definitions, and assumptions or propositions to explain a phenomenon. The theory explains how these elements are uniquely related in the phenomenon. A nursing theory is a conceptualization of some aspect of nursing communicated for the purpose of describing, explaining, predicting, and/or prescribing nursing care.
2. Describe the purpose of theory
Theories constitute much of the knowledge of a discipline. Nursing theories generate knowledge for use in practice. Theories can direct nurses on how to use the nursing process. Theories are adaptable to different clients and all care settings.
3. Theories can
provide nurses with a perspective to view client situations-give nurses a way to organize data-provide a method to analyze and interpret data
Phenomenon
An aspect of reality that people consciously sense or experience. Examples of phenomena of nursing include caring, self-care, and client responses to stress. In Neuman Systems Model (1995), phenomena include all client responses, environmental factors, and nursing actions.
Concepts
Ideas and mental images that can be simple or complex, and relate to an object or event that comes from individual perceptual experiences. Concepts help to label or describe phenomena.
Definitions
Communicate the general meaning of the concepts that make up a theory. Definitions describe the activity necessary to measure the concepts, relationships, or variable within a theory.
Assumptions
the “taken for granted” statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory.
Examples of assumptions within the context of a nursing theory include
clients are dynamic-clients have a normal range of responses-stressors attack flexible lines of defense followed by normal lines of defense-the nurse’s actions focus on primary, secondary, and tertiary prevention
Nursing’s paradigm Person
The recipient of nursing care, including individual clients, families, and communities. The person is central to the nursing care provided; care must be client centered.
Nursing’s Paradigm Health
Has different meanings for each client, the clinical setting, and the health care profession. Health is dynamic and continuously changing.
Nursing’s Paradigm Environment/Situation
Includes all possible conditions affecting the client and the setting in which health care needs occur. There is a continuous interaction between the client and the environment. This interaction can have both positive and negative effects on the client’s health and health-care needs.
Nursing’s Paradigm Nursing
The diagnosis and treatment of human responses to actual or potential health problems. The scope of nursing is broad, and many nursing diagnoses may arise from a single medical diagnosis.
Nightingale’s theory
served as an initial model for nursing. She stressed that environment should be the focus of nursing care, and that nurses need not know everything about a disease process in order to provide nursing care.
Peplau’s theory (1952)
focuses on the individual, the nurse, and the interactive process. Nursing is an interpersonal and therapeutic process. Nursing’s goal is to educate the client and the family and to help the client reach mature personality development.
Henderson’s theory
defines nursing as “assisting the individual, sick or well, in the performance of those activities that will contribute to health, recovery, or a peaceful death and that the individual would perform unaided if he or she had the necessary strength, will, or knowledge”. The goal is independence.
Rogers’ theory
considers the individual as an energy field coexisting within the universe. The individual is a unified whole, interacting with the environment, possessing personal integrity and manifesting characteristics that are more than the sum of the parts.
Orem’s self-care deficit theory
focuses on the clients self-care needs. Self-care is learned and goal-oriented. Nursing care is necessary when the client is unable to fulfill biological, psychological, developmental, or social needs.
Leininger’s theory
is based on cultural care diversity and universality. States that care is the essence of nursing, and the dominant, distinctive, and unifying feature of nursing. The goal is to provide the client with culturally specific nursing care.
Roy’s theory
views the client as an adaptive system, and the goal of nursing is to help the client adapt to changes in physiological needs, self-concept, role function, and interdependent relations during health and illness.
Watson’s theory
defines the outcome of nursing activity in regard to the humanistic aspects of life. Nursing is concerned with promoting and restoring health and preventing illness. The caring process requires the nurse to be knowledgeable about human behavior and human responses to actual or potential health problems.
Benner and Wrubel’s theory
proposes that caring is central and creates possibilities for coping, enables possibilities for connecting with and concern for others, and allows for the giving and receiving of help. Caring means that persons, events, projects, and things matter to people.
Other discipline theories
include Piaget’s theory of cognitive development (how children think, reason, and perceive the world), Maslow’s hierarchy of needs (five levels of needs), and various systems theories in which various components of a system are interrelated and share a common purpose to form a whole. An open system (the human body, the nursing process, eg.) interacts with the environment, exchanging information between the system and the environment. A closed system, such as a chemical reaction in a test tube, does not interact with the environment.
Discuss the influence of theory to practice and research:
As the nursing profession grows, there is a need for knowledge to prescribe specific interventions to improve client outcomes. The integration of theory into practice is the basis for professional nursing. Theory provides direction to nursing research, and both are needed to build nursing’s knowledge base.
Peer-reviewed articles
a panel of experts familiar with the article’s topic or subject matter has reviewed the article
MEDLINE and CINAHL
are the best-known comprehensive databases and represent the scientific knowledge base of health care
Cochrane Database of Systematic Reviews
source of synthesized evidence and protocols that provide the background, objectives, and methods for reviews
Systematic Reviews or Meta-Analyses
at the heart of EBP; a panel of experts reviews the evidence about a specific clinical question or issue and summarizes the state of the science – only reviews those studies that are randomized controlled trials (the highest level of experimental research, testing an intervention against the usual (traditional) standard of care). *Individual RCTs are the gold standard for research. In a systematic review, an independent researcher reviews all of the RCTs conducted on the same clinical issue and reports on whether the evidence is conclusive and in favor of the intervention or whether further study is necessary and why – it is the perfect answer to a PICO question.
A case control study involves:
the study of one group of subjects with a certain condition (ex. asthma) at the same time as another group that does not have the condition to determine if there is an association between one or more predictor variables and the condition.
1) Necessary loss
Are a natural part of the life course and involve change of some kind. Usually positive change occurs. (Moving on to something better.)
• Maturational losses
are a form of necessary loss and include all normally expected life changes across the life span. They are associated with normal life transitions and help people develop coping skills to use when experiencing unplanned, unwanted, or unexpected loss.
2) Situational loss
Sudden, unpredictable external events leading to loss. This type of loss experience is often negative and unexpected. May lead to loss of function, income, life goals, or self-esteem.
1) Actual loss
occurs when a person can no longer feel, hear, or know a person or object. Examples include the loss of a body part, valued object, death of a loved one, or loss of a job. Valued objects include those that wear out or are misplaced, stolen, or ruined by disaster and can elicit real grief.
2) Perceived losses
are uniquely defined by the person experiencing the loss and are less obvious to other people. Some people perceive rejection by a friend, for example, or sense a loss of confidence or status in a group. How an individual interprets the meaning of the perceived loss affects the intensity of grief response. Perceived losses are easy to overlook because they are so internally and individually experienced, although they are grieved in the same way as an actual loss. Oftentimes less obvious to others but real to that person.
Anticipatory loss
Experienced before the loss occurs.
Engel’s Stages of Grieving
➢ Shock and Disbelief
➢ Developing Awareness
➢ Resolving the loss
➢ Idealization
➢ Outcome
Sander’s Phases of Bereavement
➢ Shock➢ Awareness of Loss➢ Healing
Kubler-Ross’s Stages of Grieving
➢ Denial ➢ Anger➢ Depression➢ Acceptance
Types of Grief Response: Abbreviated
short, but genuinely felt
Types of Grief Response: Anticipated
experienced before loss
Types of Grief Response: Disenfranchised
unacknowledged
Types of Grief Response: Dysfunctional
pathological, unresolved
Types of Grief Response:Unresolved
longer and more severe
Types of Grief Response: Abbreviated
short, but genuinely felt
Types of Grief Response: Anticipated
experienced before loss
Types of Grief Response: Disenfranchised
unacknowledged
Types of Grief Response: Dysfunctional
pathological, unresolved
Types of Grief Response:Unresolved
longer and more severe
Manifestations of Grief:
Physical-Emotional-Cognitive-Behavioral
Grief: Feelings
Sorrow, Fear, Anger, Guilt or self-reproach, Anxiety, Loneliness, Fatigue, Helplessness/hopelessness, Yearning, Relief
Grief: Cognitions (Thought Patterns)
Disbelief, Confusion or memory problems, Problems with decision making, Inability to concentrate, Feeling the presence of the deceased
Grief: Physical Sensations
Headaches, Nausea and appetite disturbances, Tightness in the chest and throat, Insomnia, Oversensitivity to noise, Sense of depersonalization (“Nothing seems real”), Feeling short of breath, choking sensation, Muscle weakness, Lack of energy, Dry mouth
Greief: Behaviors
Crying and frequent sighing, Distancing from people, Absentmindedness, Dreams of the deceased, Keeping the deceased's room intact, Loss of interest in regular life events, Wearing objects that belonged to the deceased
Factors Influencing the Loss and Grief Responses
➢ Age➢ Significance of the loss➢ Culture➢ Spiritual Beliefs➢ Gender➢ Socioeconomic Status➢ Support System➢ Cause of Loss or Death
Signs of Impending Clinical Death
➢ Loss of Muscle Tone➢ Slowing of the circulation➢ Changes in respiration➢ Sensory Impairment
Heart-lung death
no vital signs
Cerebral death
cardiac activity, but permanent loss of cerebral function, absence of purposive responsiveness to external stimuli
Definition of Death adopted by the World Medical Assembly (1968)
Total lack of response to external stimuli
-No muscular movement, especially breathing
-No reflexes
-Flat encephalogram (brain waves)
Hospice care
is a philosophy and a model for the care of terminally ill clients and their families. Hospice is not a place, but rather a client- and family-centered approach to care. It gives priority to managing the client's pain and other symptoms, comfort, quality of life, and attention to physical, psychological, social, and spiritual needs and resources. Research shows the effectiveness of hospice care in meeting those goals. Clients accepted into a hospice program usually have less than 6 months to live. Hospice services are available in home, hospital, extended care, or nursing home settings.
Hospice care focuses on the following
-Client and family as the unit of care
-Coordinated home care with access to available inpatient and nursing home beds
-Control of symptoms (physical, sociological, psychological, and spiritual)
-Physician-directed services
-Provision of an interdisciplinary care team of physicians, nurses, spiritual advisers, social worker, and counselors-Medical and nursing services available at all times
-Bereavement follow-up after a client's death
-Use of trained volunteers for frequent visitation and respite support
-Acceptance into the program based on need rather than the ability to pay
To be eligible for home hospice services a client must have
a family caregiver to provide daily basic care. Home care aides offer help with hygienic needs, and a nurse is available to coordinate and manage symptom relief. Hospice team members offer 24-hour accessibility and coordinate care between the home and inpatient setting.
A client receiving home hospice care may enter the hospital for
stabilization of symptoms or for caregiver respite. As a client's death comes closer, the hospice team provides intensive support to the client and family
African Americans
Prefer having a member of the health care team clean and prepare the deceased's body. Relatively short mourning period with a memorial service and a public viewing of the body or a wake before burial. Organ donation and autopsy allowable. African Americans of Christian faith have no prescribed body preparation.
Chinese Americans
Family usually stays with deceased for up to 8 hours after death. Chinese oldest son or daughter bathes the body under direction from older relative or temple priest. Often believe the body should remain intact, so organ donation and autopsy are uncommon.
Hispanic or Latino culture
Central focus is on extended family at time of death. Family members may help with care of the body and are likely to want time with the body. Organ donation and autopsy are not common, but they are not prohibited.
Native Americans
Care of the body in the large Navajo tribe includes cleansing the body, painting the deceased's face, dressing in clothing, and attaching an eagle feather to symbolize a return home. Mourners also have ritual cleansing of their bodies. Burial sites are on the deceased's homeland.
Islamic cultures
Deceased's body is ritualistically washed, wrapped, cried over, prayed for, and buried. Non-Muslims should not touch body. Islamic law forbids cremation, because the body continues after death. At time of death deceased faces Mecca. Modesty is important, so use same-sex caregivers when possible. Autopsies are not allowed; organ donation is sometimes allowed.
Asian cultures, Buddhist faith
Recommend not touching body after death to give deceased smoother transition to the afterlife. Individuals usually minimize emotional expressions and maintain a peaceful, compassionate atmosphere. Persons often say prayers while touching and standing at the deceased's head.
Jewish cultures
In orthodox Judaism, there should be no preparation of the body until it is known whether members from the Jewish Burial Society are coming to the facility. A family member may stay with the body until burial. Usually the burial occurs within 24 hours, but not on the Sabbath. Families participate in a mourning period during which grief is expressed openly and in keeping with ritual. In some, but not all types of Judaism, cremation, autopsy, and embalming are avoided.
Discuss the nurse’s own grief experience when caring for the dying patient.
Nurses in acute care settings often witness prolonged, concentrated suffering on a daily basis, leading to feelings of frustration, anger, guilt, sadness, or anxiety. Nursing students report feeling initially hesitant and uncomfortable with their first encounters with a dying client and identify feelings of sadness, anxiety, and discomfort.
. Identify methods for nurse self-care in grief and loss.
Practice self-care, ask for and accept help, and reflect on the meaning of nursing experiences of caring for the dying client and family.
Self-reflection
an element of critical thinking, leads you to ask if your sadness is related to caring for the client or to unresolved past personal experiences. Talking with friends, a spiritual care provider, or a close professional colleague helps you begin to recognize your own grief and reflect on the meaning of caring for dying clients. Creative strategies help you cope with the loss of a person to whom you have become attached. You can gain some closure by attending a mortuary viewing or a funeral or writing a sympathy letter to the family. Develop support systems that allow time away from caregiving and focus on pleasant, nonstressful activities. Stress management techniques help to restore your energy and continued enjoyment in caring for clients. In some instances, nurses choose to work temporarily in settings where grief and death occur less frequently.
Being a professional means
knowing when to get away from the situation and care for yourself.
How do Nurses assess their own emotional well being?
Care for your physical health by eating well, exercising, engaging in relaxing activities, and by getting enough sleep. To promote emotional health, participate in calming activities such as meditation, walking, or listening to music. As noted above, developing awareness of your feelings and their source is the first step to effective emotional self-care. Given the relentless demands of caregiving, set limits on the how much you do and spend time enjoying your favorite activities. Pay attention to the people and activities that provide nurture. Learn to ask for help and accept it when someone offers.
Palliative care
The prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness, including care of the dying and bereavement follow-up for the family.
Grief
The emotional response to a loss, manifested in ways unique to an individual, based on personal experiences, cultural expectations, and spiritual beliefs
Mourning
The outward, social expressions of grief and the behavior associated with loss. Mourning rituals are culturally influenced and as such are learned behaviors.
Bereavement
Captures both grief and mourning and includes the emotional responses and outward behaviors of a person experiencing loss.
Values
- personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior.
Morals
private, personal standards of what is right and wrong in conduct, character, and attitude.
Ethics
expected standards of moral behavior of a particular group as described in the group’s formal code of ethics.
2. Discuss the role of values in the study of ethics
Since you will work with and interact with patients whose values are different from your own it is necessary to clarify your own values, such as what you value, why, and how you respect your own values even as you try to respect those of others whose values differ from yours.
Deontology
defines actions as right or wrong based on their “right-making characteristics such as fidelity to promises, truthfulness, and justice”. Does not look to consequences, instead it examines a situation for the existence of essential rightness or wrongness.
Utilitarianism
the value of something is determined by its usefulness. Also known as consequentialism. Associated with this is teology, or the study of the end. The greatest good for the greatest number of people is the guiding principle in determining right action in this system. The difference between utilitarianism and deontology is the focus on consequences or outcomes. Utilitarianism measures the effect than an act will have; deontology looks to the presence of principle regardless of outcome.
Feminist ethics
focuses on inequalities between people, looks to the nature of relationships for guidance in the processing of ethical dilemmas.
Ethics of care
focuses on understanding relationships, especially personal narratives.
Bioethics
ethics as applied to human life or health
Autonomy
right to make one’s own decisions
Nonmaleficence
duty to “do no harm”. Avoidance of harm or hurt.
Beneficence
“doing good”. Taking positive actions to help others.
Justice
fairness
Fidelity
faithful to agreements and promises.
Veracity
telling the truth
Discuss common areas of bioethics
AIDS, Abortion, Organ transplantation, End-of life issues, advanced directives, euthanasia and assisted suicide, termination of life sustaining treatment, and withdrawing or withholding food and fluids.
5. Discuss common areas of bioethics
AIDS, Abortion, Organ transplantation, End-of life issues, advanced directives, euthanasia and assisted suicide, termination of life sustaining treatment, and withdrawing or withholding food and fluids.
6. List the purposes of Nursing Code of Ethics
Inform the public about the minimum standards of the profession and help them understand professional nursing conduct.
-Provide a sign of the profession’s commitment to the public it serves.
-Outline the major ethical considerations of the profession.
-Provide ethical standards for professional behavior.
-Guide the profession in self regulation.
-Remind nurses of the special responsibility they assume when caring for the sick.
ethical dilemmas
A problem unable to be resolved through a review of scientific information and the answer will have a profound relevance for areas of human concern.
action-focused problems
a problem where you know the right thing to do, but don’t want to do it.
moral distress
situations in which the ethically appropriate course of action is known but cannot be taken due to either legal, institutional or family issues.
Discuss how to process an ethical dilemma.
Ask the question, Is this an ethical dilemma? If a review of scientific data does not answer the question, the question will have relevance for areas of human concern, then an ethical dilemma probably exists.
-Gather information relevant to the case. Client, family, institutional, and social perspectives are important sources of relevant information.
-Clarify values. Distinguish between fact, opinion, and values.
-Verbalize the problem. A clear, simple statement of the dilemma is not always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion.
-Identify possible courses of action.
-Negotiate a plan. Negotiation requires a confidence in one’s own point of view and a deep respect for the opinions of others.
-Evaluate the plan over time.
Discuss the role of the Ethics Committee in ethical decision making
They are there to obtain a decision or recommendation. A facilitator or chairperson is there to make sure the group examines all relevant points of view and all relevant data. In a successful discussion all members agree on the action, but this does not have to be the case.
Ethical process, step by step. Step 1.
Is this an ethical dilemma? If the question remains perplexing, and the answer will have profound relevance for several areas of human concern, then an ethical dilemma may exist.
Step 2.
Gather as much information as possible that is relevant to the case. Because resolution of dilemmas often comes from unlikely sources, it is helpful to incorporate as much knowledge as possible. Helpful information includes laboratory and test results, the clinical state of the client in question, and current literature about the diagnosis or condition of the client. A client's religious, cultural, and family situation are also part of the assessment.
Step 3.
Examine and determine your own values on the issues. Part of the goal is the accurate identification of one's own opinion. An equally essential part of the goal is formation of respect for others' opinions.
Step 4.
Verbalize the problem. After gathering all of the relevant information you then proceed to accurately define the problem. It is helpful to try to state the problem in a few sentences. By agreeing to a statement of the problem, the group is able to have a focused discussion
Step 5.
Consider possible courses of action. What options are possible in this situation?
Step 6.
Negotiate the outcome. Negotiations happen informally at the bedside or in a conference room. Sometimes a formal ethics meeting is necessary. Wherever negotiations occur, the nurse has an obligation to articulate a personal point of view. If an ethics committee meeting occurs, then the discussion will usually involve participants from several disciplines. A facilitator or chairperson will ensure that the group examines all points of view and identifies all relevant issues. A decision or recommendation is the usual outcome of discussion. In the best of circumstances, participants discover a course of action that meets criteria for consensus, or acceptance by all. Occasionally, however, participants leave the discussion disappointed or even opposed to the decision. But in a successful discussion, all members will have agreed on an action or decision.
Step 7.
Evaluate the action.
Supreme law of the country
Establishes the general organization of the federal government, grants certain powers to the government and places limits on what federal and state governments may do. Creates legal rights and responsibilities and is the foundation for a system of justice. The constitution ensures each US citizen the right to due process of law
Legislation (statutory law)
Laws enacted by any legislative body are called statutory laws. Federal law always supersedes; state laws supersede local laws. Regulation of nursing is a function of state law (Nurse Practice Acts)
Administrative Law
When a state legislature passes a statue, an administrative agency is given the authority to create rules and regulations to enforce the statutory laws. The state boards of nursing write rules and regulations to implement and enforce a nurse practice act which was created through statutory law.
Common Law
Laws evolving from court decisions Stare Decisis-“to stand by things decided” aka “following precedent”
Public law
refers to the body of law that deals with relationships between individuals and the government and governmental agencies.
Criminal law
segment of public law, deals with actions against the safety and welfare of the public.
Private (civil)
law-body of law that deals with relationships among private individuals.
ADA
Americans with disabilities act
-It protects the rights of disabled people. It is also the most extensive law on how employers must treat health care workers and clients infected with the human immunodeficiency virus (HIV). The Supreme Court ruled in 1998 in Bragdon v Abbott that even asymptomatic HIV constitutes a disability within the meaning of the ADA. This means that the ADA protects an HIV-positive individual who does not have acquired immunodeficiency syndrome (AIDS). The ADA regulations protect the privacy of infected people by giving individuals the opportunity to decide whether to disclose their disability. However, several cases have held that the health care provider has to disclose the fact that he or she has HIV. Despite these rulings, ADA protects health care workers in the workplace with disabilities, such as HIV infection. Likewise, health care workers may not discriminate against HIV-positive clients
Contract law
involves the enforcement of agreements among private individuals or the payment of compensation for failure to fulfill the agreements
Tort law
defines and enforces duties and rights among private individuals that are not based on contractual agreements.
Civil actions
deal with the relationships among individuals in society
Criminal actions
deal with disputes between an individual and the society as a whole
EMTALA
Emergency medical Treatment and Active Labor Act
-this act provides that when a client comes to the emergency department or the hospital, an appropriate medical screening occurs within the hospital’s capacity. This prevents patient dumping. If an emergency condition exists, the hospital is not to discharge or transfer the client until the condition stabilizes. Exceptions to this include if the client requests transfer or discharge in writing after receiving information on the benefits and risks or if a physician or health care provider certifies that the benefits of transfer outweigh the risks.
HIPAA
Health Insurance Portability and Accountability Act of 1996
-represents one of the more recent federal statutory acts affecting nursing care. This law provides rights to clients and protects employees. It protects individuals from losing their health insurance when changing jobs by providing portability. Portability allows employees to change jobs without losing coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group health insurance coverage. Privacy is the right of clients to keep information about themselves from being disclosed. Confidentiality is how health care providers treat client private information once it has been disclosed to others. HIPAA creates client rights to consent to use and disclose protected health information, to inspect and copy one’s medical record and to amend mistaken or incomplete information. It limits who is able to access a client’s record. Message boards used in client’s hospital rooms to post daily nursing care info
PSDA
Patient Self-Determination Act-requires health care institutions to provide written information to clients concerning the clients’ rights under state law to make decisions, including the right to refuse treatment and formulate advance directives. The two basic advance directives are living wills and durable powers of attorney for health care. In order for either of these to be enforceable, the client must be legally incompetent or lack decisional capacity to make decisions regarding health care treatment. Judge controls the determination of legal competency, and the physician or health care provider and family usually make the determination of decisional capacity. Decisional capacity is the ability to make right choices for oneself as it relates to medical care. Living wills represent written documents that direct treatment in accordance with a client’s wishes in the event of a terminal illness or condition. Durable power of attorney for health care is a legal document that designates a person or persons
Licensure
Legal permit that a government agency grants to individuals to engage in the practice of a profession and to use a particular title.
Licensure Must meet 3 criteria
There is a need to protect the public’s safety or welfare.
-the occupation is clearly delineated as a separate, distinct area of work
-There is a proper authority to assume the obligations of the licensing process, for example, in nursing, state boards of nursing.
Certification
Voluntary practice of validating that an individual nurse has met minimum standards of nursing competence in specialty areas such as maternal-child health, pediatrics, mental health, gerontology, and school nursing. Conducted by the American Nurses Association (ANA) and by specialty nursing organizations.
Accreditation
State board of nursing ensures that schools preparing nurses maintain minimum standards of education. Legal requirement. All states require that schools be accredited by the state boards and some require that nursing programs be approved by both state and national agencies.
State the value of having Standards of Care and list the sources of the Standards.
Purpose of Standard of care is to protect the consumer. Standards of care are the skills and learning commonly possessed by members of a profession. These standards are used to evaluate the quality of care nurses provide and, therefore, become legal guidelines for nursing practice.
Internal standards
the nurse’s job description, education, and expertise as well as individual institutional policies and procedures.
External standards
Nurse practice acts-Professional organizations (ANA, etc.)-Nursing specialty-practice organizations (Emergency Nurses Association, Oncology Nursing Society, etc.)-Federal organizations and federal guidelines (JCAHO and Medicare, etc.)
3. Define malpractice (negligence) and list the elements needed to prove negligence.
Malpractice is negligence of a health care provider, especially that which results in injury. During a trial a nursing expert testifies to the jury about the standards of nursing care as applied to the facts of the case.
Proof of Negligence
The nurse owed a duty to the client.-The nurse did not carry out the duty or breached the duty (failure to use that degree of skill and learning ordinarily used under the same or similar circumstances by members of his or her profession).
Compensation for the client was injured
Medical bills, lost wages-Pain and suffering-Perinatal damages-Wrongful death damages-The client's injury was caused by the nurse's failure to carry out that duty (“but for” the breach of duty the client would not have been injured).
List the elements which must be present for informed consent
Informed consent is an agreement by a client to accept a course of treatment or a procedure after being provided complete information, including the benefits and risks of treatment, alternatives to the treatment, and prognosis if not treated by a health care provider . The signed form is a record of the informed consent, not the informed consent itself.
General guidelines for informed consent
-The diagnosis or condition that requires treatment
-The purposes of the treatment
-What the client can expect to feel or experience
-The intended benefits of the treatment
-Possible risks or negative outcomes of the treatment
-Advantages and disadvantages of possible alternative to the treatment (including no treatment
Three major elements of informed consent
The consent must be given voluntarily
-The consent must be given by a client or individual with the capacity and competence to understand.
-The client or individual must be given enough information to be the ultimate decision maker.
Three groups of people cannot provide consent
Minors (under 18)
-Unconscious or injured in such a way that they are unable to give consent
-Mentally ill persons who have been judged by professional to be incompetent
Describe the nurse’s role regarding a “do not resuscitate” order.
• The competent client’s values and choices should always be given highest priority, even when these wishes conflict with those of the family or health care providers.
• When the client is incompetent, an advance directive or the proxy decision makers acting for the client should make health care treatment decisions.
• A DNR decision should always be the subject of explicit discussion between the client, the client’s family, and designated decision maker acting on the client’s behalf, and the health care team.
• DNR orders must be clearly documented, reviewed and updated periodically to reflect changes in the client’s condition. Such documentation is required to meet standards of the JCAHO.
• A DNR order is separate from other aspects of a client’s care and does not imply that other types of care should be withdrawn, for example, nursing care to ensure comfort or medical treatment for chronic but non-life-threatening illnesses.
Caring is
a universal phenomenon influencing the ways in which people think, feel, and behave in relation to one another.During times of illness or when a person seeks the professional guidance of a nurse, caring is essential in helping the individual reach positive outcomes.
Patricia Benner and Wrubel
• caring through the interpretation of expert nurses' stories.
• the essence of excellent nursing practice is caring.
• Caring means that persons, events, projects, and things matter to
• “Caring creates possibility.”
• Through caring, nurses help clients recover in the face of illness, give meaning to that illness, and maintain or reestablish connection.
• Caring helps nurses identify successful interventions, and this concern then guides future caregiving.
• Caring facilitates a nurse's ability to know a client, allowing the nurse to recognize a client's problems and to find and implement individualized solutions.
• Through caring relationships, nurses learn to listen to clients' stories about their illness so that they obtain an understanding of the meaning of illness. With this understanding, they provide therapeutic, client-centered care.
Madeleine Leininger; Transcultural perspctive
• Caring is an essential human need
• Caring helps an individual or group improve a human condition.
• Acts of caring refer to the nurturant and skillful activities, processes, and decisions to assist people in ways that are empathetic, compassionate, and supportive.
• An act of caring is dependent on the needs, problems, and values of the client.
• Care is vital to recovery from illness and to the maintenance of healthy life practices in all cultures.
• Caring is very personal and differs for each client.
• Nurses need to learn culturally specific behaviors and words that reflect human caring in different cultures to identify and meet the needs of all clients
Jean Watson; Transpersonal caring
• A conscious intention to care promotes healing and wholeness
• Transpersonal caring theory rejects the disease orientation to health care and places care before cure
• A connection forms between the one cared for and the one caring. The model is transformative, because the relationship influences both the nurse and the client, for better or for worse
Discuss potential implications when nurse/client perceptions of caring differ.
• When clients sense that health care providers are sensitive, sympathetic, compassionate, and interested in them as people, they usually become active partners in the plan of care.
• Williams (1997) studied the relationship between clients' perceptions of four dimensions of caring and their satisfaction with nursing care. Clients in the study indicated that they were more satisfied when they perceived nurses to be caring.
Sr. Simone Roach 5 C’s of caring:
Compassion, Confidence, Competence, Conscience, Commitment
1. Compassion
being sensitive to client suffering or problems
2. Confidence
being confident in own ability to take care of others
3. Competence
patients need someone who performs safely and efficiently
4. Conscience
Ethics, knowing what is the right thing to do for the patient and doing it
5. Commitment
service is altruistic, it is not just a job
5 conceptualizations of caring
1. Caring is a human trait (it’s part of human nature)
2. Caring as Moral Imperative (we have to care because it’s the right thing)
3. Caring as an Affect (the feeling, or emotional response we have)
4. Caring as an Interpersonal Interaction (entering into a relationship)
5. Caring as an Intervention (when we care, we do something for others)
Watson
• Caring provides the stance from which one intervenes as a nurse. This stance is critical for ensuring that nurses practice ethical standards for good conduct, character, and motives.
• If clients accept the nurse, they will invite him or her to see, share, and touch their vulnerability and suffering. One's human presence never leaves one unaffected
• Spirituality offers a sense of connectedness as well, intrapersonally (connected with oneself), interpersonally (connected with others and the environment), and transpersonally (connected with the unseen, God, or a higher power).
In a caring relationship, the client and the nurse come to know one another so that both move toward a healing relationship by doing the following
• Mobilizing hope for the client and for the nurse• Finding an interpretation or understanding of illness, symptoms, or emotions that is acceptable to the client• Assisting the client in using social, emotional, or spiritual resources• Recognizing that caring relationships connect us human to human, spirit to spirit.
Providing Presence
a person-to-person encounter conveying a closeness and a sense of caring
.• “being there” nurse is attentive
• “being with” nurse give himself or herself
• eye contact, body language, voice tone, listening, and having a positive and encouraging attitude act together to create an openness and understanding.
Touch
The use of touch is one comforting approach where the nurse reaches out to clients to communicate concern and support.
• Contact touch involves skin-to-skin contact
• noncontact touch refers to eye contact.
• Nurses use task-orientated touch when performing a task or procedure.
• Caring touch is a form of nonverbal communication, which successfully influences a client's comfort and security, enhances self-esteem, and improves reality orientation
• Protective touch is a form of touch used to protect the nurse and/or client
Listening
In a caring relationship the nurse establishes trust, opens lines of communication, and listens to what the client has to say
• To listen effectively, listeners need to silence themselves to listen with openness
• Through active listening, you begin to truly know your clients and what is important to them
Knowing the client
The concept comprises both the nurse's understanding of a specific client and the nurse's subsequent selection of interventions responses to therapies, routines and habits, coping resources, physical capacities and endurance, and body typology and characteristics
• To know a client means that the nurse avoids assumptions, focuses on the client, and engages in a caring relationship with the client that reveals information and cues that facilitate critical thinking and clinical judgments
Spiritual caring
Spiritual health occurs when a person finds a balance between his or her own life values, goals, and belief systems and those of others
Family care
Success with nursing interventions often depends on the family's willingness to share information about the client, the family's acceptance and understanding of therapies, whether the interventions fit with the family's daily practices, and whether the family supports and delivers the therapies recommended.• Showing the family care and concern for the client creates an openness that then enables a relationship to form with the family.
Explain how an ethic of care influences nurses decision making
• Through caring for other human beings, ultimately human dignity is protected, enhanced, and preserved.• The term ethics refers to the ideals of right and wrong behavior. • An ethic of care is concerned with relationships between people and with a nurse's character and attitude toward others. • Nurses who function from an ethic of care are sensitive to unequal relationships that lead to an abuse of one person's power over another—intentional or otherwise.
Describe how caring can be made more visible.
• health care has to become more humanizing. This begins by nurses' making caring a part of the philosophy and environment in the workplace. • Incorporating care concepts into standards of nursing care establishes the guidelines for professional conduct. • Nurses need to be committed to caring and be willing to establish the relationships necessary for personal, competent, compassionate, and meaningful nursing care.
Leadership definition
"The process of influencing others”.
Management definition
Management involves not only leadership but also “coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific institutional goals and objectives”.
Leaders
-Derive power from personal influence
-Have goals that may or may not reflect those of the organization.
-Direct willing followers
Managers
-Have assigned position,
-Legitimate source of power
-Emphasize control, decision making, decision analysis, and results
-Direct willing and unwilling subordinates.
Team nursing
Team members provide care under the supervision of an RN
Total client care
The RN works directly with the client
Primary nursing
RN assumes the caseload of clients during their entire stay
Case management
RN maintains responsibility for client care from admission to discharge
List characteristics of leaders
• empowerment to other- achievement, belonging, self-esteem
• intuition- a "feeling" for people and actions
• self-understanding- strengths and weaknesses
• vision- seeing a better way, and how to achieve it
• values congruence- reconcile values of persons and that of the organization
• charismatic
faith and belief in leader
• authoritarian (directive)
guides group
• Laissez-faire
non-directional, permissive
• situational
varies with group or situation
• transactional
manages day to day tasks
• transformational
stresses importance of preparing people for change
Describe elements of decentralized decision making
• Occurs at unit level
Principles of time management
-goal setting -time analysis (review how you spend your time)-priority setting (set priorities for clients within set time frame)-interruption control (use time designated for reports, mealtime or team meetings to socialize or discuss issues. Plan time to assist clients)-evaluation
Management Skills
keeping a to-do list, completing one task before starting another, prioritize goals
Clinical decisions
obtain initial complete assessment and frequent shift assessments in order to make accurate clinical decisions• Priority setting
• Organizational skills
be effective (doing the right things) and efficient (doing things right)
• Use of resources
'members of the healthcare team'
• Time management
Establish personal goals/time frames
• Evaluation
This does not occur at the end of an activity, but is an ongoing process
5 rights of delegation:right task
the right task is one that is delegable for a specific client, such as tasks that are repetitive, require little supervision, are relatively non-invasive, have results that are predictable, and the potential risk is minimal.
5 rights of delegation:right circumstances
the appropriate client setting, available resources, and other relevent factors are considered. In an acute setting, clients' conditions can change quickly. Good clinical decision making is needed to determine what to delegate.
rights of delegation:right supervision
appropriate monitoring, evaluation, intervention as needed, and feedback provided. Assistive personnel should feel comfortable asking questions and seeking assistance.
a. Health promotion
activities, such as routine exercise and good nutrition, help clients maintain or enhance their present level of health. Health promotion activities motivate people to act positively to reach more stable levels of health.
b. Wellness
education teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self-responsibility. Wellness strategies help persons achieve new understanding and control their lives.
c. Illness prevention
activities such as immunization programs protect clients from actual or potential threats to health. Illness prevention activities motivate people to avoid declines in health or functional levels.
List 2 major Healthy People public health goals for America.
a. To increase quality and years of healthy life.
b. To eliminate health disparities.
Health Belief Model 3 components
i. The individual’s perception of susceptibility to an illness.
ii. The individual’s perception of the seriousness of the illness.
iii. The likelihood that a person will take preventive action-results from the person’s perception of the benefits of and barriers to taking action.
Health Promotion Model designed to be a
“complementary counterpart to models of health protection”. It defines health as a positive, dynamic state, not merely the absence of disease. Health promotion is directed at increasing a client’s level of well-being.
Each person has unique personal characteristics and experiences that affect subsequent actions. Focuses on 3 areas
i. Individual characteristics and experiences
ii. Behavior-specific knowledge and affect
iii. Behavioral outcomes
Basic Human Needs Model aka Maslow’s Hierarch of Needs
elements that are necessary for human survival and health (ex. food, water, safety and love). Individualized but most of them follow the basic pyramid.
Maslow's from bottom to top:
Physiological; oxygen, fluids, nutrition, body temperature, elimination, shelter, sex.
Safety and Security; physical safety, psychological safety. Love and belonging needs.
Self-esteem.
Self-actualization. To provide the most effective care, the nurse needs to understand the relationships of different needs and the factors that determine the priorities for each client individually.
Holistic Health Model
attempts to create conditions that promote optimal health. In this model, nurses using the nursing process consider clients the ultimate experts regarding their own health and respect clients’ subjective experience as relevant in maintaining health or assisting in healing. Clients are involved; therefore assume some responsibility for health maintenance.
Precontemplation
not intending to make changes within the next 6 months
Contemplation
considering a change within the next 6 months
Preparation
making small changes in preparation for a change in the next month
Action
actively engaged in strategies to change behavior. This stage may last up to 6 months.
Maintenance Stage
sustained change over time. This stage begins 6 months after action has started and continues indefinitely.
Primary Prevention
true prevention; precedes disease or dysfunction and is applied to clients considered physically and emotionally healthy. Aimed at health promotion.
Secondary
focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the client to return to a normal level of health as early as possible.
Tertiary
occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration.
Discuss risk factor modification and changing health behaviors.
Identifying risk factors is the first step in health promotion, wellness education, and illness prevention activities. Risk factor modification, health promotion or illness prevention activities, or any program that attempts to change unhealthy lifestyle behaviors can be considered a wellness strategy. Changing health behavior is difficult, especially those behaviors that people ingrain in their lifestyle patterns. The role of nurses’ using a health promotion model for identification of risky behaviors and implementation of the change process cannot be overemphasized, because it is the nurse who spends the greatest amount of time in direct contact with clients. An understanding of the process of changing behaviors can help nurses support difficult health behavior change in their clients. It is believed that change involves movement through a series of stages. See #5 for the stages and process.
Definition of illness
a state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with previous experience. Illness can be either acute or chronic.
Illness:
Illness is never an isolated life event. The client and family must deal with changes resulting from illness and treatment. Each client responds uniquely to illness, requiring nurses to individualize nursing interventions. The client and family commonly experience behavioral and emotional changes as well as changes in roles, body image and self-concept, and family dynamics.
9. Discuss the nurse’s role in health and illness.
a. Health and illness must be defined in terms of the individual. Nurses’ attitudes toward health and illness should consider the total person, as well as the environment in which the person lives, to individualize nursing care and enhance meaningfulness of the client’s future health status.
1. A nurse who is planning a program on lifestyle and behavior change should include which topic in the program?
a. Smoking cessation Rationale Smoking cessation is a lifestyle/behavior change. Alcohol and drug abuse programs are classified as information dissemination. Health risk appraisal is a wellness program. Toxic and nuclear waste emissions are environmental programs problems.
2. Which intervention would be least effective when assisting a client in making behavior changes that would reduce his health risk factors?
a. Ask the client to follow a plan you wrote for him. Rationale: In planning these changes, the client should develop a plan, two or three goals, and a time frame for implementing the changes. Writing a plan for the client would be least effective, as it does not allow the client a say in the plan. Client decision-making is a critical element in success.
3. A client has failed to follow the plan that was developed for health promotion. What would be the most effective response by the nurse?
a. Discard the idea that the client must change. Rationale: Understanding that the client may not change is a key for the nurse. Forced changed will not work. Assuming lack of motivation, noncompliance, and starting over may be detrimental. The client needs to decide with the nurse if the change is possible, and reevaluate the plan.
4. The two major goals of Healthy People 2010 reflect the nation's changing demographics. These goals include which of the following?
a. Increase quality and years of healthy life and eliminate health disparities Rationale: The changing demographics reflect the aging population and the diversity of the population. These are both reflected in the goals, which include increasing quality and years of healthy life and eliminating health disparities. The other answers could be ways to implement these goals, but are not goals themselves.
5. According to Prochaska, Norcross, and DiClemente (1994), which stage in health behavior change would include the client's acknowledging a problem?
a. Contemplation stage Rationale: The client acknowledges a problem in the contemplation stage. The client denies a problem in the precontemplation stage, prepares for a change in the preparation stage, and implements the change in the action stage.
6. The majority of individuals who relapse during a health behavior change return to which stage for reevaluation?
a. Contemplation stage Rationale: The majority of individuals will return to the contemplation stage to think about what they learned and plan for the next action attempt.
7. When performing a health risk assessment, it is important to remember that this assessment is intended to indicate the client's risk over how many years?
a. Ten years Rationale: A health risk assessment is intended to indicate the client's risk over the next ten years.
8. On the health style self-test, a client scores 5 on most sections. What action by the nurse would be most beneficial to this client?
a. Asking the client if he would like information about the risks he is facing Rationale: A score of 3-5 indicates health risks. It would be beneficial for the nurse to ask the client if he would like more information about the risks he is facing.
9. Which nursing diagnoses are included in the NANDA taxonomy for a wellness diagnosis? (Select all that apply.)
a. Readiness for enhanced spiritual well-being, Readiness for enhanced knowledge, Readiness for enhanced parenting Rationale: The following examples are included in the NANDA taxonomy: Readiness for enhanced spiritual well-being, readiness for enhanced coping, readiness for enhanced nutrition, readiness for enhanced knowledge, readiness for enhanced parenting, and readiness for enhanced self-concept.
10. Which factors impact health promotion and illness prevention with the elderly? (Select all that apply.)
a. Presence of one or more chronic diseases, change in cognitive status, increase in physical limitations. Rationale: Factors to beware of that might indicate a need for additional information include the following: an increase in physical limitations, presence of one or more chronic diseases, change in cognitive status, difficulty in accessing health care services die to transportation problems, poor support systems, need for environmental modifications for safety and maintain independence, and attitude of hopelessness and depression.