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225 Cards in this Set
- Front
- Back
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Nursing practices:
Code of Ethics |
compassion and respect for the inherent dignity, worth and uniqueness of every individual; regardless of soc/econ status, personal attributes, nature of health problems
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Primary commitment:
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the PATIENT, whether individual, family, group or community
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Promotes, advocates for and strives to protect:
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health, rights and safety of the patient
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Responsible and accountable for:
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individual nursing practice
appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care |
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Duty to self:
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owes same duties to self as to others
responsibility to preserve integrity and safety maintain competence continue personal and professional growth |
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Participates through individual and collective action:
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establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality healthcare and consistent with the values of the profession
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Participates in the advancement of the profession:
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contributions to practice
education administration knowledge development |
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Collaborates with:
in promoting community, national and international efforts to meet health needs |
other health professionals
the public |
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The PROFESSION of nursing, as represented by associations and their members:
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is responsible for articulating nursing values
maintaining the integrity of the profession and it's practice and for shaping social policy |
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American Nurses Assoc Social Policy Statement
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a document that nurses can use as a framework for understanding nursing's relationships with society and nursing's obligation to those who receive nursing care
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Nursing is:
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dynamic, not static
reflects the changing nature of societal needs |
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Underlying values and assumptions:
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essential unity of mind/body/spirit
human experience is contextually and culturally defined health and illness are human exper presence of illness does not preclude health optimal health does not preclude illness |
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Features of professional nursing
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attention to the full range of human exper and responses to health and illness w/o restriction to a problem-focused orientation
integration of objective data with knowledge gained from understanding of pt or groups subjective experience application of SCIENTIFIC KNOWLEDGE to the processes of DX and TX provision of a caring relationship that facilitates health and healing |
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Levels of Practice
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psych-mental health nurses are qualified to practice nursing at 2 levels, basic and advanced; differentiated by edu preparation, practice complexity, and skill to perform certain nsg functions
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Basic Level of practice
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BSN
practice in the field of psych -mental health nsg for a min of 2 yr demonstrates the skills nec as outlined in the Scope and Standards of Psych-Mental Health Nsg Practice (2000) document |
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Basic Level Tasks
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using interventions to foster and promote optimal mental health
assessing dysfunction assisting pt in regaining or improving their coping abilities maximizing their strengths preventing further disability admin and monitoring psychobiolgical tx regimens (meds) assisting and monitoring pt in self-care activities case management, counseling and crisis care health maint and promotion health teaching intake screenings, eval milieu therapy (therapeutic environ) psychiatric rehab |
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Advanced Level Practice
APRN-PMH |
licensed RN
masters degree nationally certified as a clinical specialist in psych mental health nsg Clinical practice focuses on indiv dx with psychiatric DO and other vulnerable indiv & populations at risk with mental health DO |
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Advanced Level Tasks
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all the duties of basic level PLUS
complete delivery of direct primary mental health care services to clients |
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Advanced Level - direct primary mental health care services
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health assessment/examination
health screening and evaluation individual, family, group and network psychotherapy designing and conduction mental illness preventive intervention directing and providing home health services to mental health patients formulating differential dx based on clinical findings formulating, implementing and evaluating an outcome-based tx plan planning and carrying out health promotion activities ordering, conducting and interpreting pertinent lab and diagnostic studies and procedures prescribing, monitoring, managing and eval psychopharm and related meds providing integrated mental health services in general health settings referring to another clinician |
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Nursing Responsibility
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practicing nursing in accordance with state laws.
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Case Management Activities: APRN-PMH
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utilization of population specific nsg knowledge along with research, knowledge of mental health w/in the legal system, supportive psychotherapy expertise in obtaining necessary psych care for a pt in order to maximize pt outcomes
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Clinical Supervisory Responsibilities:
APRN-PMH |
providing clinical supervision, peer consultation, peer supervision
this is a professional and educative developmental processe for growth; NOT a staff performance evaluation |
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Community Interventions:
APRN-PMH |
assesses the health needs of populations w/in the community and designs programs for at-risk populations.
attention to cultural, developmental and environ factors w/in the community is necessary |
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Consultation-liaison Activities
APRN-PMH |
focus on emotional, developmental, spiritual, behavioral and cognitive responses of pt in health care areas such as hosp, rehab centers and outpt facilities.
may include assessing and rec actions that focus on the health care delivery organization as the client |
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Psychopharmacology Interventions
APRN-PMH |
prescription of pharm agents use to treat mental DO
ordering and interpretation of dx and lab tests seek optimal pt outcomes anticipates side effects ensures against adverse drug reactions/interactions |
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Psychotherapy
APRN-PMH |
psychotherapy to alleviate emotional distress, assist in reversing or changing negative behavior, assist in facilitating growth
brief or long-term therapy to indiv, couples, families, groups (behavioral, insight, solution-focused, Gestalt, psychoanalytic, play therapy and others) |
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Scope of Practice
APRN-PMH |
established by the profession and published through the professional assoc for nurses, the ANA
licensed and approved by their indiv states each state has it's own requirements, rules and regs certification available at the generalist and specialist levels for psych mental health nsg additional certifications may be nec based on specialization of practice |
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ANA (2000) definition psych mental health nsg
APRN-PMH |
"Psychiatric-mental health nsg is the dx and treatment of human responses to actual or potential mental health problems;
it is a specialized area of nsg practice." |
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Settings
APRN-PMH |
intermediate and long-term care: hosp, AODA, in-pt units, correctional facilities.
An essential role is to assist the client's smooth transition from the institution to the community setting. Community based care: homes, schools, worksites, EAP, HMOs, senior centers, foster care, shelters, emergency and crisis centers, clinics, nsg homes Telecommunications: electronic communication, telephone consults, interactive video sessions, computers, faxing, e-mail, image transmission, research, edu programs |
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Self-Employment
APRN-PMH |
provide direct services to clients through private practice, group practice settings, managed care, health provider org, home health agencies and other service delivery agreements.
provide consultation-liaison services for an organization and it's staff may form a nurse-owned corporation to compete with other providers |
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Primary Mental Health
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the continuous and comprehensive services necessary for promotion of optimal mental health; the prevention of mental illness; health maintenance; management of and referral for, mental and physical health problems; the dx and tx of mental DO and their sequelae, and rehabilitation.
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APRN-PMH is able to
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provide assessment
diagnose utilizing nsg dx based on NANDA, DSM-IV, or the International Classification of Diseases (WHO 1993) identify outcomes plan interventions or tx based on assessment data and theoreticas hypotheses evaluate effectiveness of the process and revise the plan of care to ensure optimal pt outcomes |
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Phenomena of Concern of psych-mental health nurses includes actual or potential mental health problems of clients such as:
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maintenance of optimal mental health and well-being and the prevention of mental illness
self-care limitations or impaired functioning r/t mental, emotional, and physiological distress deficits in the functioning of significant biological, emotional and cognitive systems emotional stress or crisis r/t illness, pain, disability and loss self-concept and body image changes, developmental issues, life process changes and end-of -life issues problems r/t emotions such as anxiety, anger, confusion, fear, grief, loneliness, powerlessness and sadness physical sx that occur aonlg with altered physiological functioning alterations in communicating, decision-making, perceiving, symbolizing and thinking difficulties relating to others behaviors and mental states that indicate the patient is a danger to self or others or has a severe disability symptom management, side effects/toxicities associated with self-administered drugs, psych meds and other features of the tx regimen interpersonal, environmnetal circumstances or events, organizational, sociocultural, and spiritual issues that have an impact on the mental and emotional well-being of the indiv, family, or community |
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Subspecialization
APRN-PMH |
addiction
depression serious and persistent mental illness community, group, couple, family or individuals specific role/function - case management, psych consultation/liaison |
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Clinical Nurse Specialist Roles
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expert clinician
clinical supervisor educator consultant researcher administrator |
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Advanced Clinical Practice
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expert and thoroughly skilled in providing care
delivers care that is performed confidently and in a timely manner provides expert role modeling is aware of prevention of complications regardlses of the disease process or diagnostic entity strives for personal excellence and quality patient care is an expert coach to patients may or may not exercise prescriptive privileges The expert practitioner subrole must continue to be the central focus for the role of Clinical Nurse Specialist. |
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Clinical Supervision
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a formal process of support and learning that enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety in complex situations
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Types of Supervision
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Clinical- focus on professional competencies
Managerial- concerned with accountability and the monitoring of work commissioned by an organization. Group- supervision provided w/in a group format (professionals are accountable to one another). Training - acquisition of specific skills and competencies; accountability is to the educational establishment |
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Clinical Supervision
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enables a focus on professional competencies and increases the potential for a high standard of delivery of care to patients and their families.
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Managerial Supervision
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concerned with accountability and the monitoring of work commissioned by an organization.
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Group Supervision
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supervision provided w/in a group format (professionals are accountable to one another).
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Training Supervision
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acquisition of specific skills and competencies; accountability is to the educational establishment
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Clinical Nurse Specialist training/certification
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supervision needs to be provided by another CNS or a psychiatrist or psychologist - someone who has expert knowledge relevant to the focus of clinical supervision.
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Three Modes of Supervision
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Patient-Centered
Clinical-Centered Process-Centered |
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Patient Centered Supervision
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nurse brings to supervision problems of a technical nature
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Clinical-Centered Supervision
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centers on unseen, unheard, or unspoken aspects of professional practice. The nurse is helped to reflect on events concerned with complex human dynamics and is encouraged to think about factors influencing his/her clinical practice (outside awareness).
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Process Centered Supervision
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focuses on processes of events as they unfold between a pt, family members, or colleagues, a nurse and supervisor, and interactions between the pt and nurse (mirroring or paralleling).
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Benefits of Clinical Supervision
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can influence other professional alliances, including those with pt and families
provide opportunities to gain valuable experiential knowledge of building and establishing constructive relationships repair professional attitudes and restore an aptitude for work during exhausting professional demands be regarded as a means of support, personal development and maintaining integrity can build confidence in the nursing role; reduce stress, burnout and sickness levels increase nurses' job satisfaction Benefits of clinical supervision increase with longer duration of participation in clinical supervision. |
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Supervisee
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define the guidelines w/in which you are to work with your supervisor in supervision
discuss, explore working boundaries, confidentiality, accountability, parameters and limits identify ways of gaining support through clinical supervision and supervisor establish dates, times and length of clinical supervision document exchanges |
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Effective supervisee behaviors
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reflect on practice and implement changes as needed
seek supervision and prepare by identifying cases or issues be open to change, seek input/feedback meet regularly be honest about what you do and do not know ask a lot of questions be teachable follow suggestions given in supervision listen objectively, be approachable |
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Roles of the Supervisor
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have a close relationship with own supervisor
recognize when things are going well identify potential areas of difficulty devise ways of working with uncertainty allow time for supervisees to evaluate their practice structure the relationship and professional conversations offer a structured pathway, model, or framework for keeping the professional relationship appropriate and the session focused |
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Effective Supervisor Behaviors
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present cases for discussion
co/joint interviewing direct observation role play audio and video recording and review provide relevant literature teach therapeutic skills hold supervisee accountable communicate directly acknowledge supervisee experience, knowledge be willing to lesten and able to give clear direction and feedback stay w/in the guidelines of your expertise as a supervisor give honest evaluative feedback encourage and affirm supervisee growth discuss theoretical frameworks for approaching practice/supervision |
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Establishing a Clinical Supervision Relationship
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be aware of competing roles (manager/boss/supervisor)
discuss and review individual and joint responsibilities at the beginning of the relationship negotiate and agree upon tentative working guidelines for clinical supervision take time to assess how well the process is progressing define the guidelines w/in which you are to work document exchanges discuss, explore working boundaries, confidentiality, accountability, parameters and limits identify personal ways of gaining support more effectively do we wish to work together? can we work together? do our roles allow us to work together? establish dates, times and length of clinical supervision |
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Clinical Supervision Models
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Restorative
Formative Normative ALSO Prescriptive Informative Confronting Cathartic Catalytic Supportive |
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Restorative Model of Supervision
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providing support in an attempt to relieve the stress of the job of nursing
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Formative Model of Supervision
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educative, developing skills understanding, and ability by reflection
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Normative Model of Supervision
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maintenance of professional standards
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Prescriptive Model of Supervision
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offer advice and make suggestions
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Informative Model of Supervision
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offer information or instruction
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Confronting Model of Supervision
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challenge the individual's behavior, attitudes, or beliefs
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Cathartic Model of Supervision
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enable the release of tension and strong emotion
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Catalytic Model of Supervision
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encourage further self-exploration, self-directed living, learning, and problem solving
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Supportive Model of Supervision
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validate or confirm the worth and value of the client's person, qualities, attitudes, or actions
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Cognitive Therapy Supervision Model
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focused, structured, educational and collaborative
increase awareness of how our own cognitions can influence ther therapeutic endeavor and how we can use our cognitions to understand the process of CT uncovers suprevisee's thought/feelings about relationship with clients with added modeling effect of demonstrating how to work through similar emotions in the client acknowledge that the practice of supervisor and supervisee will be influenced by own core beliefs, underlying assumptions and automatic thoughts supervision sessions are structured by an agenda and aim to make links across sessions aims to summarize previous session content and review any learning that has occurred between sessions may include review of audio and videotapes of supervisee's work airm to help supervisee apply CT as well as they can and to develop assessment, conceptualization and tx skills |
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Cognitive therapy supervision agenda: example
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personal update
agenda setting link to last supervision session previously supervised cases check on homework task discuss agenda items assignment of new homework summary and feedback from supervisee |
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Learning Process Supervision Model:
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STATUS QUO > DISORIENTATION >naming the problem>EXPLORATION > sharing the discovery > REORIENTATION > reflection > TESTING > disconfirmation>DISORIENTATION continues as a cycle
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Four STAGES of learning process sequence
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disorientation - crisis of confidence
exploration - collaborative and open ended reorientation - major insight or synthesis experience simultaneous with a new approach to the learning task testing - sharing the discovery with others |
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Four PHASE TRANSITION POINTS learning process sequence
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naming the problem - without blame
sharing the discovery - gather insights, confidence and satisfaction reflection - disconfirmation |
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Learning Process Sequence
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the learner achieves a change in perspective through 4 stages and 4 phase transition points. The pivotal transition is the move from a state of equilibrium (status quo) to a state of disorientation that occurs when expectations are thwarted by experience
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Equilibrium: learning process sequence
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new perspective and approach is elaborated, refined, and applied
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Education: CNS - subrole of the educator
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teaches individuals, couples, families, communities, systems
teaches w/in schools of nursing, colleges provides info to resolve health problems and improve the quality of care functions as a role model and preceptor for nurse generalists and for faculty and students in a variety of clinical areas curriculum development teaches content teaches continuing education programs follows adult learning principles |
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Adult Learning Theory
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teaching = creating an environment where learning can occur
teacher is the facilitator teacher guides the learning learning = change learner has the responsibility to do the learning learning is active, experiential, holistic, involving the individ and his environment teaching is the facilitation of learning, involves sharing and mutual experience of learning on the part of both teacher and learner |
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Teaching Strategies
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topic of interest
clear and measurable goals complete a literature search, get nec materials develop content organize material in systematic fashion gear presentation to the audience select appropriate teaching strategies use a variety of teaching aids if possible assess learner needs prior to the presentation |
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Domains of Learning
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Cognitive learner
Kinesthetic learner = by doing Affective learner = by feeling Visual learner = by seeing Auditory learner = by hearing |
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Evaluation - types
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Formative eval: written words placed on an evaluation
Summative eval: essential points, adding all key points from individual eval and compiling them into one eval |
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Objectives
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must be measurable and attainable
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Learning Process
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active and continuous
dependent upon readiness influenced by life experiences facilitated when info has relevance to the learner facilitated by proceeding from simple to complex, known to unknown facilitated when learner can test, analyze, be creative, take risks facilitated when learner has knowledge of his progress toward the goal enhanced in situations in which satisfaction is derived facilitated by recognition of similarities and differences between past and present situations influenced by the learner's perception more effective when there is immediate application of what is being taught most effective when self directed and applies to learners daily activities more effective when the learner is motivated to learn a continuous process, improved by doing reinforce when appealing to several senses |
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Reinforced Learning
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people remember
10% of what they read 20% of what they hear 30% of what they see 50% of what they see and hear 80% of what they say 90% of what they say while doing |
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Consultation
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interactive, supportive, interpersonal process in which the consultant collaborates with the consultee who has requested assistance with problem solving. The consultant has NO direct authority or evaluative responsibilities over the consultee.
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Internal consultant
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CNS evaluates a medical patient secondary to a psych problem.
CNS is called upon for a professional opinion r/t staffing issues. |
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External consultant
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CNS provide advice re: appropriateness of potential referrals for psych home care
provides clinical suggestions for managing difficult behaviors in the home setting/nsg home. CNS acts as an organizational consultant |
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Interdisciplinary Consultation
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accept diff perspective w/in the organization in which you are consulting
be able to function interdependently roles negotiated between team members constantly review and challenge ideas take risks possess personal identity and integrity accept the team's philosophy of care establish new interaction patterns accept changes in authority and status develop methods of conflict resolution and decision making |
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Intradisciplinary Consultation
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a peer or colleague relationship in which the CONSULTEE defines the problem
usually brief, short series of visits increases the capacity of the consultee to master future, similar problems the consultant does not counsel staff, but refers for counseling if that is the problem the consultee does NOT have to take the consultant advice |
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Collaboration
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developing relationships with key individuals and developing collaborative relationships with individuals who know key individuals
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Collaboration strategies
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planning inservices
coaching staff to develop assertiveness and conflict resolution skills developing and participating in specific programs requiring collaboration making oneself indispensable to the parties involved (work effectively with pt other caregivers find difficult to manage) developing scope of practice statements for institutions that employ CNSs developing clinical protocols in joint practice committees being instrumental in identifying situations that would benefit from standing clinical protocols engaging in joint review of medical records |
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Four phases of consultation
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entry, beginning of the consultation request
diagnosis response or intervention closure and evaluation |
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Steps of consultation
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assessment of the consultation problem following the consultation request
the consultation report implementation of the consultant's request follow-up |
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Types of Mental Health consultation
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Client centered
consultee centered program centered administrative consultee centered administrative |
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Examples of consultation/liaison activities
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unit based education programs
patient education programs participation in discharge planning nursing care planning facilitation of patient, family or staff nurse support groups |
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Change Agent
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one who works to make, modify or make something different than the status quo
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Facilitators of change
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desire to change
motivation to change positive past experience with change not perceiving change as a threat trust in the change agent a change that can be clearly communicated and described support and involvement from others adequate resources accurate diagnosis of the problem solution appropriate to the problem determining what roles will be assumed |
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Planned Change
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conscious, deliverate and collaborative effort to improve the operations of a human system through utilization of valid knowledge
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Change Strategies
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power/coercive
normative/re-educative emperical/rational |
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Choosing a Change Strategy
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depends on the anticipated maturity of followers (motivation, competence).
determine desired level of functioning have realistic expectations foster independence by maximizing strengths |
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Considerations in Change
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independence is a long process
acute patients need nurturing higher functioning patients need less nurturing behavior that has been useful over long periods of time takes time to change change will be resisted and at times may be sabotaged coping skills need to be adequate to deal with growth realistic goals depend on other supports in the community the family should be involved |
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Barriers to change
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desire to maintain the status quo
satisfaction with the status quo change is perceived as a threat lack of motivation to change negative past experience with change lack of trust in the change agent poor communication change is of an abstract nature so difficult to communicate clearly lack of support from others inadequate resources unrealistic, incongruent solution fear of failure lack of understanding as to what is needed to change |
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Satir and Change
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no need to focus on the extinction of old learning
change will occur through the additive process of transformation and atrophy By focusing on new way of doing things or coping that is better than the old way, the individual will start using the new way and the old way will die of disuse. |
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Process of Learning
Satir |
enhanced and maximized when the individual feels supported and this willing and able to take risks.
when indiv exposed to new behavioral learning, they need to take only what fits for them, rejecting knowledge with which they are not comfortable. |
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Role of the Therapist
Satir |
use strategic questions to help the client find his own answers.
learning process is a discovery/rediscovery by the learner of knowledge that is already within; the answers to the questions are found w/in the individual who asks them |
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Johari Window
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awareness model to understand the principles of change
contains 4 quadrants |
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Consciousness
Johari |
refers to what is felt w/in oneself
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Awareness
Johari |
refers to what is felt outside oneself
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Quadrant 1
Johari |
the open quadrant, refers to behavior, feelings and motivation that is known to self and others
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Quadrant 2
Johari |
the blind quadrant, refers to behavior, feelings and motivation that is known to others but not to self
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Quadrant 3
Johari |
the hidden quadrant, refers to behavior, feelings and motivation that is known to self, but not to others
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Hypothesis
Research |
statement of researcher's expected outcome based on his rationale.
hypothesis are not proven, only tested contain dependent and indepent variables |
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Independent Variable
Research |
considered the cause, and it occurs first
it is a stimulus or activity that is used to create an effect on the dependent variable |
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Dependent Variable
Research |
depends on and occurs after the independent variable
is affected by the independent variable it is the variable of interest, the one you want to explain or predict |
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Design
Research |
the plan or organization of the study
the blueprint to maximize the control of the study |
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Plan Elements
Research |
manipulation
randomization control conditions constancy of conditions: manipulation of the indep variable comparison group randomization extraneous individual characteristics |
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Study Populations
Research |
target population must be delineated
sample population represents a miniature of the larger population |
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Probability sampling
Research |
investigator can specify for each element of the population the probability that it will be included in the sample
sampling units are selected by chance simple random sampling, stratified random sampling or cluster sampling are considered in this category |
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Nonprobability sampling
Research |
investigator has no ability to estimate the probability that each element of population can or will be a part of the sample, or even that it has a chance of being included
nonprobability samples do not permit generalization beyond the current study group confounding factors may influence this type of sampling more than random sampling, making the findings of less potential value to a broader population |
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Convenience Sampling or Accident sampling
Research |
simply taking those individuals who are available
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Purposive Sampling or Judgment Sampling
Research |
the investigator establishes certain criteria and subjects are selected according to these criteria
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Sample Size Considerations
Research |
target population size
it is desirable for generalization to occur beyond the study population group outcomes for decision making are important use a large enough sample to be representative of your target population group use the largest group you can w/in the constraints you have determined for your study the larger the sample, the less error in measurement, the more significant and generalizable the findings if using a homogeneous group, the smaller the sample size may be a N (number) less than 35-40 subjects reduces ability to use strong powerful statistical treatment of the data |
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Informed Consent
Research |
Law estab by Congress 1974
Protection of Human Subjects in Biomedical and 'Behavioral Research Law requires true informed consent by any indiv before becoming a subject in a research project |
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Informed Consent information
Research |
nature and purpose of the research study
duration of the research study methods and procedures by which the data will be collected how the data will be used all inconveniences, potential harm, or discomfort that might reasonably be expected from the study the result, effects, and side effects that may result from participation in the study the right to stop participation in the study at any time the expectation that data will remain confidential |
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Characteristics of Research Study
Research |
validity
reliability usability |
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Validity
Research |
VALIDITY IS THE MOST IMPORTANT CHARACTERISTIC OF A MEASURING DEVICE.
how well a test or instrument measures what it is supposed to measure. it evaluates what it is supposed to evaluate it is a true measure of something A VALID TEST MUST HAVE BOTH RELIABILITY AND VALIDITY. validity is never 100% it is important to determine whether the validity of an instrument is sufficient to be used for the purpose of the particular study under investigation. |
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Reliability
Research |
how WELL a measuring instrument measures something
how consistent it is in measuring something expressed as a coefficient number 1.00-100% reliable a correlation coefficient of 0.80 or higher is considered acceptable the amt of reliability needed is determined by the purpose for which the instrument is used and the vital/crucial decision that will be made from the findings the more crucial the decision making, the more validity and reliability are needed to have confidence in the measure an instrument may be reliable w/o being valid |
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Outcomes of research depend on:
Research |
quality of the research gathering instruments
appropriate population group/sample appropriateness of measures used, validity and reliability the extent to which effective useful data analysis techniques can make the findings meaningful and useful for predetermined purposes PRETESTING self developed instruments is a must |
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Data
Research |
two types:
qualitative quantitative |
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Qualitative Data
Research |
words, descriptions in narrative form, concepts, facts, verbatim statements of the subjects, linguistic approaches
IN NURSING SOME AREAS OF FREQUENT STUDY ARE CONCERNED WITH WELLNESS AND ILLNESS, VARIABLES NOT EASILY AMENABLE TO QUANTIFICATION. |
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Quantitative Data
Research |
numbers
quantification enhances precision of studies much less subjective statistical analysis techniques can be used with numbers |
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Levels of Measurement
Research |
Nominal - numbers can be given to names
Ordinal - numbers are given to rank Interval - numbers have meaning as numbers Ratio - numbers can be analyzed |
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Reasons to be able to use research and statistical methods
Research |
to read literature and studies with scrutiny and skill to apply findings in clinical practice and work environ
to conduct research in nsg to take the science of nsg back to basic scientific foundations and to make new applied research applications to patient needs to move nsg from intuitive ways of knowing to replicable and tested ways of deliberate nsg interventions in pt care to move nsg closer to other applied health fields in basic foundations and tested practices to collaborate with colleagues in medicine to seek better healthcare practices |
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Types of Research
Research |
Demonstrative Research
Replication Research Evaluation Research |
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Demonstrative Research
Research |
seeks to prove that facts already accepted really exist.
hunches are not operationalized |
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Replication Research
Research |
sets out to repeat or reproduce a research project to see if the findings are correct the same in the same or in a different setting
replicate research to determine reliability of findings from initial study |
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Evaluation Research
Research |
analysis of a program, project, agency in terms of specific goals or objectives and results to see if things were accomplished as the program stated it was to be done
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Mean
Research |
represents average score of the sample
used with interval or ratio data total score/number of scores in the sample |
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Median
Research |
simply a point on a scale with half of the total scores above the point and half of the scores below the point
used with ordinal data or any rating scale |
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Mode
Research |
category that occurs with greatest frequency
THE ONLY APPROPRIATE MEASUREMENT FOR NOMINAL DATA |
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Standard Deviation
Research |
the distance of each subject from the group mean
requires interval or ratio data describe how widely indiv in a sample group vary the sum of the variations of all members in a class/group from the class mean an average of the average |
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Inferential Statistics
Research |
process of generalizing from sample observation, the probability of it applying to a whole population
aim is to determine the acceptability of the hypotheses |
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Criteria Checklist for a Research Study
Research |
is the title: readily understood
clear clearly related to content |
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the Research Problem
Research |
is introduced early in the proposal
questions to be answered are stated precisely the problem statement is clear hypotheses are stated in a form that permits them to be tested limitations of the study can be identified assumptions of the study can be identified pertinent terms are/can be operationally defined significance of the problem is discussed research is justified |
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Review of the Literature
Research |
cited literature is pertinent to the research problem
relationship of the problem to previous research is made clear a conceptual framework/theoretical rationale is clearly stated |
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Methodology
Research |
subjects
instruments design data collection |
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Subjects
Research |
population is described
sampling method is described sampling method is justified sampling size is sufficient standards for protection of subjects are discussed |
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Instruments
Research |
relevant reliability data from previous research are presented
reliability data pertinent to presented study are reported validity data pertinent to present study are reported methods of data collection are sufficiently described to permit judgment of their appropriateness to the present study |
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Design
Research |
is appropriate to study questions and hypotheses
proper controls are included where appropriate variables are/can be identified description of design is explicit enough to permit replication |
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Data Collection
Research |
info presented is sufficient to answer research questions
statistical tests to be used are identified |
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Peplau's Theory
Nsg Theories |
focused on the nurse-client relationship
draws from developmental, interpersonal and learning theories describes several overlapping phases of nurse-client relationship with changing goals and roles as the relationship progresses |
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Peplau's Definition of Nursing
|
a significant, therapeutic, interpersonal process that aims to promote a patient's health in the direction of creative, constructive, productive, personal, and community living
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Peplau's Phases of the Relationship
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orientation
identification exploitation resolution |
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Orem's Self-Care Model
|
nursing is based upon the patient's or the community's self-care deficit
provide assistance to individuals and systems which because of health conditions, cannot provide self-care self-care deficits occur when health-related problems require nursing care |
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Johnson's Systems Model
|
man is a behavioral system comprised of eight subsystems of behavior
individuals are bio-psycho-socio-cultural beings strive to maintain system balance/homeostasis with some degree of regularity and consistency of behavior actively seek new experiences an individual is an open system with 8 broadly defined subsystems interacting with the environment by receiving input and displaying behavioral output disruptions in one subsystem may cause disruption in others all subsystems need to be assessed for possible changes in system stability |
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Eight Subsystems
Johnson's Systems Model |
ingestive
eliminative dependence affiliative achievement aggressive-protective sexual-reproductive |
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Subjects
|
population is described
sampling method is described sampling method is justified sampling size is sufficient standards for protection of subjects are discussed |
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Instruments
|
relevant reliability data from previous research are presented
reliability data pertinent to presented study are reported validity data pertinent to present study are reported methods of data collection are sufficiently described to permit judgment of their appropriateness to the present study |
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Design
|
is appropriate to study questions and hypotheses
proper controls are included where appropriate variables are/can be identified description of design is explicit enough to permit replication |
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Data Collection
|
info presented is sufficient to answer research questions
statistical tests to be used are identified |
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Peplau's Theory
Nsg Theories |
focused on the nurse-client relationship
draws from developmental, interpersonal and learning theories describes several overlapping phases of nurse-client relationship with changing goals and roles as the relationship progresses |
|
|
Peplau's Definition of Nursing
|
a significant, therapeutic, interpersonal process that aims to promote a patient's health in the direction of creative, constructive, productive, personal, and community living
|
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|
Peplau's Phases of the Relationship
|
orientation
identification exploitation resolution |
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|
Orem's Self-Care Model
|
nursing is based upon the patient's or the community's self-care deficit
provide assistance to individuals and systems which because of health conditions, cannot provide self-care self-care deficits occur when health-related problems require nursing care |
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|
Johnson's Systems Model
|
man is a behavioral system comprised of eight subsystems of behavior
individuals are bio-psycho-socio-cultural beings strive to maintain system balance/homeostasis with some degree of regularity and consistency of behavior actively seek new experiences an individual is an open system with 8 broadly defined subsystems interacting with the environment by receiving input and displaying behavioral output disruptions in one subsystem may cause disruption in others all subsystems need to be assessed for possible changes in system stability |
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Eight Subsystems
Johnson's Systems Model |
ingestive
eliminative dependence affiliative achievement aggressive-protective sexual-reproductive |
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Ingestive
Johnson's systems model |
taking in nourishment in socially and culturally acceptable ways.
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Eliminative
Johnson's systems model |
ridding system of waste in socially and culturally acceptable ways
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Dependence
Johnson's systems model |
self-dependence and interdependence
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Affiliative
Johnson's systems model |
security
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Achievement
Johnson's systems model |
mastery of self and environment according to an internalized standard of excellence
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Aggressive-Protective
Johnson's systems model |
survival
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Sexual-reproductive
Johnson's systems model |
procreation and gratification
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Restorative
Johnson's systems model |
rest and sleep
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Therapeutic communication
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in psychiatric nursing communication and interactions can be the therapy
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Broad opening statements
Therapeutic Communication Techniques |
open ended statements allow the pt to set the direction of the conversation
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General leads
Therapeutic Communication Techniques |
acknowledge that you are listening and understanding "Yes, go on"
don't over use or the patient may feel rushed or interrupted |
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Reflecting
Therapeutic Communication Techniques |
repeating all or part of what the patient has said
encourages pt to continue helps to clarify that you heard what was said |
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Selective Reflecting
Therapeutic Communication Techniques |
nurse takes a more directive approach to guiding the conversation
select the most important idea contained in what the pt has said and direct it back to the pt. |
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Clarifying
Therapeutic Communication Techniques |
nurse immediately asks for clarification if any part of what the pt has said has not been understood to prevent misunderstanding
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Sharing observations
Therapeutic Communication Techniques |
nurse shares observations regarding the pt behavior as a way to help the pt understand his emotions
ie: your hands are shaking, you seem upset |
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Acknowledging the Pt's Feelings
Therapeutic Communication Techniques |
indicates that the pt's feelings are understood and accepted
encourages pt to continue expressing their emotions |
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Using Silence
Therapeutic Communication Techniques |
remaining silent AND attentive
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Giving Information
Therapeutic Communication Techniques |
education is a PRIMARY NURSING FUNCTION
provide specific information |
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Verbalizing Implied Thoughts and Information
Therapeutic Communication Techniques |
the nurse voices what the pt seems to have implied
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Validating
Therapeutic Communication Techniques |
asking the patient if their needs/wants are being met, etc
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Using Reassuring Cliche's
Blocks to Therapeutic Communication AND Alternatives |
minimizes the patient's concerns
share your observations instead and let the patient interpret |
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Giving Advice
Blocks to Therapeutic Communication AND Alternatives |
imposes opinions and solutions on the pt
is inappropriate clarify and use other communication techniques to help pt come to their own solutions |
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Giving Approval or Agreeing with the Pt
Blocks to Therapeutic Communication AND Alternatives |
this can be a useful response OR BE A BLOCK TO COMMUNICATION by changing the focus of the discussion to the nurse's values or feelings
try silence or reflection |
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Requesting an Explanation
Blocks to Therapeutic Communication AND Alternatives |
asks the pt to immediately analyze and explain his feelings or actions, patients can't always do this
stay with the feeling instead don't rush the process |
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Expressing Disapproval
Blocks to Therapeutic Communication AND Alternatives |
imposes the nurse's values on the pt and implies that the nurse is entitled to make a negative value judgment regarding the pt feelings or behavior
express your input as giving information share personal reactions with a colleague |
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Minimizing or Belittling the Pt's Feelings
Blocks to Therapeutic Communication AND Alternatives |
deny the importance of the pt's feelings as unique "I know just how you feel."
shifts the focus from the pt to the nurse or others use acknowledging the pt's feelings or sharing information instead |
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Disagreeing with the Pt
Blocks to Therapeutic Communication AND Alternatives |
although this can be used appropriately as a reality check, it can indicate that what the pt said has not been accepted
use giving information instead |
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Stereotyped Comment
Blocks to Therapeutic Communication AND Alternatives |
keeps the conversation at a superficial level ie: "isn't it a beautiful day?"
try starting with a broad opening statement instead |
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Changing the Subject
Blocks to Therapeutic Communication AND Alternatives |
the nurse directs the course of the conversation
this may make the pt feel unimportant and abandoned identify the source of your discomfort and work it through, then you will be able to use silence and really listen |
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Defense Mechanisms
|
an internal and often unconscious process
may be healthy or unhealthy serve several purposes: PRIMARILY handle tensions and anxieties ALSO make us look better to others, help us to be loved and accepted, to achieve success and recognition |
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Coping Strategies
|
external responses to a stressful situation
they are problem solving |
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Rationalization
Defense Mechanisms |
process whereby one expresses the reason for a behavior to justify it
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Suppression
Defense Mechanisms |
the conscious dismissal of an unacceptable idea, desire, painful memory, etc from the mind
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Denial
Defense Mechanisms |
the refusal to acknowledge
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Repression
Defense Mechanisms |
an unconscious process that prevents or hinders an idea, desire, memory, etc from reaching consciousness
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Regression
Defense Mechanisms |
a return to an earlier stage of development
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Fantasy
Defense Mechanisms |
use of playful imagination
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Projection
Defense Mechanisms |
unconscious attribution to another of one's own thoughts, feelings, or actions
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Dissociation
Defense Mechanisms |
to keep something separate and apart in one's mind
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Conversion
Defense Mechanisms |
changing of one thing into another, e.g. emotional pain becomes a physical manifestation
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Displacement
Defense Mechanisms |
transference of emotion from the original idea it was associated with to a different idea
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Introjection
Defense Mechanisms |
identification of the self with another or with some object, thereby assuming the supposed feelings of the other individual
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Isolation
Coping Strategies |
placing oneself apart and alone
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Splitting
Coping Strategies |
the process of pitting one individual against another to avoid focus on oneself
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Devaluing
Coping Strategies |
minimizing the individual attempting to help or intervene to avoid the issue
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Substitution
Coping Strategies |
turning from an obstructed or inappropriate desire to one whose gratification is socially acceptable
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Sublimation
Coping Strategies |
conversion of unwanted aggressive or sexual drives into socially acceptable channels
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Compensation
Coping Strategies |
seeking a substitute for something lacking or unacceptable
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Over-Compensation
Coping Strategies |
the process by which an individual substitutes an opposite trait or exerts efforts in excess of what is needed to compensate
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Identification
Coping Strategies |
to consider as being the same or as being necessarily associated
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Symbolism
Coping Strategies |
everything that occurs is interpreted as a symbol of the patient's own thoughts
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Patient Rights
Legal Aspects of Care |
psych patients have specific and general rights
specific rights can vary from state to state rights of institutionalized pt are extablished by the state statutes and vary greatly |
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Adequate Treatment
Legal Aspects of Care |
Patient Rights:
a humane psychological and physical environment qualified personnel to provide individualized care individualized treatment plans be released if not dangerous to aftercare |
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Basic Rights typically covered by statute
Legal Aspects of Care |
issues of confidentiality
issued of involuntary detention send and receive mail consult with personal physician, attorney or clergy visitation unless documented reasons for denial to use personal possessions unless documented reasons for denial privacy and private storage space treatment in the least restrictive manner to refuse treatment or medication to refuse psychosurgery or ECT to receive help from patient advocates |
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Strip Search
Legal Aspects of Care |
patients are protected from strip and search except when valid consent is obtained or when there is adequate justification under the circumstances
any time strip and search is done it must be documented as a DENIAL OF RIGHTS stating why it was done |
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Denial of Rights
Legal Aspects of Care |
any time any of these rights are denied, there must be a sound reason and it must be documented
DENIAL OF RIGHTS CAN NEVER BE PUNITIVE |
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Informed consent
Legal Aspects of Care |
in most states pt must give written permission to be given psychotropic meds except in an emergency and on a one time basis
pts must give informed consent to receive ECT pt must sign and understand a written informed consent to participate in any research protocols VOLUNTARY hosp pt must sign consent for treatment at the time of admit INVOLUNTARY hosp pt cannot give this consent |
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Confidentiality
Legal Aspects of Care |
confidentiality is an important aspect of care
there are state and hospital specific laws, policies and procedures pt have the right for no one to know that they are in a psych facility sign a form stating what info they are willing to have shared if someone inquires about them |
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Violation of Confidentiality
Legal Aspects of Care |
there are times when confidentiality may be violated:
if a pt is an imminent threat to himself or others if a pt makes a threat to harm a specific individual the mental health professional must notify that individual per the TARASOFF LAW if the health professional suspects physical, sexual or financial abuse, he must report it to the appropriate authority |
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Tarasoff Law
Legal Aspects of Care |
law requiring mental health professionals to notify an individual if a patient makes a specific threat to harm that individual
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Involuntary Detention
Legal Aspects of Care |
can be placed by a police officer, psychiatrist or other designees appointed by the state
in some states a psychiatric nurse clinician has this authority |
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Reasons an individual can be involuntarily committed for a psych eval
Legal Aspects of Care |
they are a danger to themselves due to mental illness
they are a danger to others due to a mental illness they are gravely disabled due to a mental illness |
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|
Duration of initial hold
Legal Aspects of Care |
up to 72 hours
during that time only a PSYCHIATRIST can discontinue it |
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14 day Certification
Legal Aspects of Care |
if the individual is still considered a danger to himself or others or is gravely disabled, he can be placed on an additional 14 day certification, but a court hearing must be held to uphold this
there are longer involuntary detentions in certain situations, such as a danger to others |
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Conservator
Legal Aspects of Care |
indiv who are chronically mentally ill and unable to care for themselves may be given a conservator, who is someone appointed to make their decisions for them and who has the authority over individual and/or finances
these laws vary from state to state |
