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119 Cards in this Set
- Front
- Back
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Level 1, 2, & 3 in the nursing curriculum covers??
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Level 1: Wellness and Minor Disruption in Health
Level 2: Acute Illness and Disruptions Level 3: Chronic and Complex Disruptions |
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Nursing as defined by the ANA
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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
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Florence Nightingale
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Nightingale established the first nursing philosophy based on health maintenance and restoration. Her views on nursing came from a spiritual philosophy. She saw the role of nursing as having "charge of somebody's health" based on the knowledge of "how to put the body in such a state to be free of disease or to recover from disease". During the same yar, she developed the first organized program for training nurses, the Nightingale Training School for Nurses at St. Thomas' Hospital in London.
Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentary. She viewed nursing as a search for truth in finding answers to health care questions or discovering and using God's laws of healing in nursing practice. In 1853 Nightingale went to Paris to study with the Sisters of Charity and was later appointed superintendent of the English General Hospitals in Turkey. During this period she brought about major reforms in hygiene, sanitation, and nursing practice. She volunteered during th eCrimean War in the 1850s and traveled the battlefield hospitals at night carrying her lamp; she thus was known as the "lady with the lamp." The sanitary, nutrition, and basic facilities in the battlefield hospitals were poor at best. Eventually she was given the task to organize and improve the quality of the sanitation facilities. As a result, the mortality rate at the Barracks Hospital in Scurtari, Turkey, was reduced from 42.7% to 2.2% in 6 months. She was the first researcher and developed the pie chart. |
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Clara Barton
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Clara Barton, founder of the American Red Cross, tended soldiers on the battlefields, cleansing their wounds, meeting their basic needs, and comforting them in death. The US Congress ratified the American Red Cross in 1882 after 10 years of lobbying by Barton.
volunteer in Civil War, American Red Cross |
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Dorothea Dix
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As superintendent of the female nurses of the Union Army, Dix organized hospitals, appointed nurses, and oversaw and regulated supplies to the troops.
Conditions of mental hospital, American Army Nursing Service, Civil War |
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Mother Bickerdyke
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Mother Bickerdyke organized ambulance services, supervised nurses, and walked abandoned battlefields at night, looking for wounded soldiers.
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Harriet Tubman
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Harriet Tubman was active in the Underground Railroad movement and assisted in leading over 300 slaves to freedom.
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Mary Mahoney
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The first professionally trained African American nurse was Mary Mahoney. She was concerned with relationships between cultures and races, and as a noted nursing leader, she brought forth an awareness of cultural diversity and respect for the individual, regardless of background, race, color, or religion.
First Professional Black Nurse 1879 |
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Isabel Hampton Robb
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Isabel Hampton Robb helped found the Nurses' Associated Alumnae of the US and Canada in 1896. This organization became the American Nurses Association in 1911. She authored many nursing textbooks.
John Hopkins Superintendent for Higher Education, Founder of ANA & NL of Nursing Education |
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Lillian Wald & Mary Brewster
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Lillian Wald and Mary Brewster opened the Henry Street Settlement, which focused on the health needs of poor people who lived in tenements in New York City. (1890s??)
Henry Street Settlement, NY; Wald Suggested national health insurance plan |
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Mary Adelaide Nutting
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Nutting was instrumental in the affiliation of nursing education with universities. She became the first professor of nursing at Columbia University Teachers College in 1906.
coursework before clinical practice, associated program with university, first nurse university professor |
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Nursing advances in 1900's?
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Army Nurse Corps
Navy Nurse Corps Graduate nurse-midwifery Specialty-nursing organizations |
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What are some societal influences on nursing?
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Demographic Changes
Women's Health Care Issues Human Rights Movement Medically Underserved Threat of Bioterrorism |
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General ways to meet the needs of your consumer, the patient?
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being culturally aware and competent
focusing on client safety promoting health and wellness in the community |
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Hippocratic Oath
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an oath historically taken by doctors and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students.
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Name some early hospitals (8th century and such)
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Pheobe, Deaconess & First Visiting Nurse
Fabiola, First Large Hospital, Rome Hotel Dieu, Lyons, France |
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Linda Richards
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First trained nurse, nurses notes, physician orders 1874
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Lavina Dock
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Henry Street Settlement, Suffragettes, Editor AJN, Textbook,
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Margaret Sanger
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Planned Parenthood, Birth control program
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Mary Breckinridge
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Frontier Nursing Service, KY
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Luther Christman
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Advocated advanced clinical degrees for nurses, BSN for entry, nursing academy, and founded American Assembly for Men in Nursing (1975)
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Goldmark Report (Rockefeller), 1918
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Identified that the biggest set back to nursing education was that the needs of the hospitals were put before the needs of the students. Service vs. Education.
This report said that nursing should be put into universities rather than just hospitals. |
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Brown Report, 1936
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Focus on higher education, nursing as a profession for all (men as well)
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Lysaught Report, 1965
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National Committee on Nursing and Nursing Practice
(1) Research should be increased in both the practice and education of nurses. (2) Educational systems should be enhanced and curriculum based on research. (3) Financial support should be increased for nurses and for nursing. |
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ANA Position Statement, 1965
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This document, which divided the health and nursing community, took a stand on the level of education which the nurse should attain before she/he entered practice
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Institute of Research & Service in Nursing Education, 1955
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increased practical nursing school. (provided grants, resources, and sanctions)
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National Commission on Nursing, AHA, 1980
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BSN education
education mobility clinical education |
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Institute of Medicine (IOM), 1979
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nursing education funding
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Social Security Act, 1935
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Social Welfare and Social Insurance Programs
Benefits elderly, child welfare, & training health care professional |
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Medicare & Medicaid, 1965
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Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other special criteria.
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. |
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Nurse Training Act, 1964
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The act not only enhanced the quality of nursing education by pouring more money in to nurse training programs, but also attracted more people into the nursing field by establishing loan and grant programs for those interested in becoming nurses.
scholarships, loans & schools |
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Social Security Act Amendments, 1977
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allowed payment Nurses Practitioners
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Omnibus Budget Reconciliation, 1980
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Payment midwives
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Nurse Reinvestment Act, 2003
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More Nurses
Provides educational scholarships in exchange for commitment to serve in a public or private non-profit health facility determined to have a critical shortage of nurses. |
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Lillian Wald, Plan for National Health Insurance
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Wald established a nursing insurance partnership with Metropolitan Life Insurance Company that became a model for many other corporate projects, suggested a national health insurance plan
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Hospitals offered, 1920, Baylor Plan
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The precursor to Blue Cross was founded in 1929 by a group of Dallas teachers who contracted with Baylor University Hospital to provide 21 days of hospitalization for a fixed $6.00 payment. The Baylor plan developed as a way to ensure that people paid their bills.
Pre-Paid plan |
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Blue Cross & Blue Shield, 1930’s
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Blue Cross Designed to Reduce Price Competition among Hospitals
Blue Shield: Insurance for Physician Services Thus, to protect themselves from competition with Blue Cross, as well as to provide an alternative to compulsory insurance, physicians began to organize a framework for pre-paid plans that covered physician services (Blue Shield). |
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HMO Act, 1977
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A health maintenance organization (HMO) is a type of managed care organization (MCO) that provides a form of health care coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract.
dual choice provision |
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Societal Trends Affecting Nursing—19th Century
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Industrial Revolution
Urbanization Emigration War Germ Theory Suffragettes |
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Societal Trends Affecting Nursing—20th Century
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Wars & Conflict
Women’s Movement Knowledge & Technology Explosion Population Trends Economic Trends & Health Care Financing |
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Societal Trends Affecting Nursing—21th Century
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Demographic Changes
Women’s Health Care Issues Human Rights Movement Medically Underserved Threats of Bioterrorism Knowledge & Technology Explosion Economic Trends & Health Care Financing |
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National League for Nursing (NLN)
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The NLN advances excellence in nursing education to prepare nurses to meet the needs of a diverse population in a changing healthcare environment.
NLN sets standards in nursing education |
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American Nursing Association (ANA)
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ANA's purpose is to improve standards of health and the availability of health care, to foster high standards for nursing, and to, promote the professional development and general economic welfare of nurses.
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International Council of Nurses (ICN)
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The objectives of the ICN parallel those of the ANA, seeking a higher status for nurses and providing international power base for nurses.
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What is a Profession? And what are its criteria?
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A profession is a calling that requires special knowledge, skill, and preparation
Flexner: Complex occupation Person-oriented Altruistic service Long training Organized Potter and Perry: Extended Education Theoretical Body of Knowledge Provides a Specific Service Code of Ethics |
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American Nurses' Association (effect on Profession)?
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Improve standards of health
Improve availability of healthcare Standards for nursing Promote professional development Economic and General Welfare Activities = Research Economic and General Welfare Communication Continuing Education Legal/Political Representation Standards |
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National League for Nursing (effect on Profession)?
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Advances excellence in nursing education
Ensure the public need for nursing is met. Sponsors the National League for Nursing Accrediting Commission National League for Nursing Accrediting Commision = Accredits schools of nursing: LPN, Diploma, BSN, higher degrees. |
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American Association of College Nursing (effect on Profession)?
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establish quality standards for bachelor's- and graduate-degree nursing education,
assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate education, research, and practice in nursing Supports the Commission on Collegiate Nursing Education |
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Commission on Collegiate Nursing Education (effect on Profession)?
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autonomous accrediting agency contributing to the improvement of the public's health (formed by AACN).
CCNE ensures the quality and integrity of baccalaureate and graduate education programs preparing effective nurses. |
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Sigma Theta Tau International (effect on Profession)?
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International Nursing Honor Society
Promotes leadership and scholarship in nursing, recognize superior achievement, foster high professional standards. |
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National Student Nurses Association (effect on Profession)?
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Founded in 1952, NSNA is a nonprofit organization for students enrolled in associate, baccalaureate, diploma, and generic graduate nursing programs.
It is dedicated to fostering the professional development of nursing students. TUSNA |
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Nurse Practice Acts (NPAs) are regulated by whom? And What do they regulate?
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State Board of Nursing
Regulate the scope of nursing practice and protect public health, safety and welfare. |
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Professional Standards Review Organization (PSROs)?
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The federal government created PSROs to review the quality, quantity, and cost of hospital care.
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Utilization Review Committees (UR)
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Medicare-qualified hospitals had physician-supervised UR to review the admissions, diagnostic testing, and treatments provided by physicians who cared for clients receiving Medicare.
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Prospective Payment System (PPS)
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One of the most significant factors that influenced payment for health care was the PPS. Established by Congress in 1983, the PPS eliminated cost-based reimbursement. Hospitals serving clients who received Medicare benefits were no longer able to charge whatever the client's care cost. Instead, the PPS grouped inpatient hospital services for Medicare clients, DRGs.
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Dignosis-Related Groups (DRGs)
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Each group had a fixed reimbursement amount with adjustments based on case severity, rural/urban/regional costs, and teaching costs. Hospitals receive a set dollar amount for each client based on the assigned DRG, regardless of the client's length of stay or use of services in the hospital.
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Capitation
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Most health care providers use capitations. It means the providers received a fixed amount per client or enrollee of a health care plan. The aim of capitation is to build a payment plan for select diagnoses or surgical procedures that consists of the best standards of care, including essential diagnostic and treatment procedures at the lowest cost.
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Resource Utilization Groups (RUGs)
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Many now use DRGs in the rehabilitation setting, and RUGs in long term care. In all settings, health care providers make efforts to manage costs so that the organizations remain profitable.
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United States Health care delivery system issues and new focus?
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Issues =
rising cost of health care increased access to services a growing population improved quality of outcomes threats of bioterrorism As a result, the emphasis of the health care industry today is shifting from managing illness to managing health of a community and the environment. |
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Health Services Pyramid
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Population-based Health care services
Clinical preventive services Primary Health Care Secondary Health Care Tertiary Health Care |
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Examples of Primary Care
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prenatal care
well-baby care nutrition counseling family planning exercise classes |
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Examples of Preventative Care
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blood pressure and cancer screening
Immunizations poison control information mental health counseling and crisis prevention Community legislation |
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Examples of Secondary Acute Care
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Emergency Care
Acute medical-surgical care radiological procedures |
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Examples of Tertiary Care
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Intensive Care
Subacute Care |
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Examples of Restorative Care
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Cardio and Pulmonary Rehabilitation
Sports Medicine Spinal Cord injury programs home care |
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Examples of continuing care
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assisted living
psychiatric and older adult day care |
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Managed Care Organization (MCO)
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Provides comprehensive preventaive and treatment services to a specific group of voluntarily enrolled persons
Focus on health maintenance, primary care. All provided by a primary care physician. Referral needed for access to specialist and hospitalization |
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Preferred Provider Organization (PPO)
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One that limits an enrollee's choice to a list of "preferred" hospitals, physicians, and providers. An enrollee pays more out-of-pocket expenses for using a provider not on the list.
Focus on Health Maintenance. Contractual agreement exists between a set of providers and one or more purchasers. Discount to those under contracts. |
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Exclusive Provider Organization (EPO)
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One that limits an enrollee's choice to providers belonging to one organization. Sometimes able to use outside providers at additional expense.
Less access to select specialists |
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Private Insurance
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Traditional fee-for-service plan. Payment computed after client receives services on basis of number of services used.
Typically expensive Most policies have deductibles that clients have to meet before insurance pays. |
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Long-Term Care Insurance
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Supplemental insurance for coverage of long-term care services. Policies provide a set amount of dollars for an unlimited time or for as little as 2 years.
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Where would be a place to receive Preventive and Primary Care?
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schools, physician offices, occupational health clinics, and nursing centers
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Where would be a place to receive Secondary and Tertiary Care?
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Hospitals, Intensive Care Units, Psychiatric Facilities, and Rural Hospitals
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Where would be a place to receive Restorative Care?
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Home Health Care, Rehabilitation, Extended Care Facilities
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Where would be a place to receive Continuing Care?
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Nursing Centers, Assisted Living, Respite Care, Adult Day Care Centers, Hospice
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The greater the out of pocket expense the greater the uninsured and we see an increase in provider accountability
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Memorize:
The greater the out of pocket expense the greater the uninsured and we see an increase in provider accountability |
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Mortality
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Death rates
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Morbidity
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Rate or incidence of a disease, readmit, length of stay
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National Association for Healthcare Quality (NAHQ)
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a professional association dedicated to the advancement of the profession of healthcare quality and patient safety and the individual professionals working in the field.
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Agency for Healthcare Research and Quality (AHRQ)
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to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. As 1 of 12 agencies within the Department of Health and Human Services, AHRQ supports research that helps people make more informed decisions and improves the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research.
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Recipients and Expenditures for Medicaid
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Low-income parents and children
73% of Medicaid recipients, 27.5% of Medicaid expenditures. Aged, disabled, and mentally handicapped 27% of Medicaid recipients 72.5% of all expenditures. |
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Oklahoma Nurse Practice Act
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The practice of Nursing means the performance of services provided for purposes of nursing diagnosis and treatment of human responses to actual or potential health problems consistent with educational preparation”
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Definition
Registered nursing |
means the practice of the full scope of nursing which includes, but is not limited to:
a assessing the health status of individuals, families and groups, b. analyzing assessment data to determine nursing care needs, c. establishing goals to meet identified health care needs, d. planning a strategy of care, e. establishing priorities of nursing intervention to implement the strategy of care, f. implementing the strategy of care, g. delegating such tasks as may safely be performed by others, consistent with educational preparation and that do not conflict with the provisions of the Oklahoma Nursing Practice Act, h. providing safe and effective nursing care rendered directly or indirectly, i. evaluating responses to interventions, j. teaching the principles and practice of nursing, k. managing and supervising the practice of nursing, l. collaborating with other health professionals in the management of health care, m. performing additional nursing functions in accordance with knowledge and skills acquired beyond basic nursing preparation, and n. delegating those nursing tasks as defined in the rules of the Board that may be performed by an advanced unlicensed assistive person; |
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Roles of the Nurse
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Care provider
Same as in ancient times Interdependent Decision Making Researcher: Data collection Information sharing / communicator Patient Advocate Unique position Defined by: Level of education Standards of care - practice Oklahoma nurse practice act |
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Role Behaviors of Nurse
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Manager
Communicator Decision maker Coordinator Educator Evaluator Delegator Performer - implementer Client advocate |
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Healthcare Teams
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Two or more people working collaboratively on an issue
Teams are necessary because Increased complexity of care Increased technology Increased specialization of team members Effectiveness/success requires Respect Commitment Communication |
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Group Process
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Forming – are you in or out?
Storming - battle for power Norming - rules of membership Performing - work gets done Adjourning - summarize and feedback Patient as Captain |
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Most Frequent Reasons for Team Failure
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The team had allowed some other issue to replace the work focus of the group.
Control - who’s in charge Socialization Personal success Incompetent team members - technical skill and membership ability. Team rarely met therefore poor communication |
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Nursing Role of Collaboration in the Team
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Manage group process
Communicate effectively Participate in Decision making Act as Coordinator when appropriate cooperate with coordinator Educate and be open to learning Keep a Client focused orientation Advocate for client when necessary |
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Methods to Increase Team Effectiveness
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COMMUNICATE OFTEN
Clear definition of roles and goals Access to each other - Location, time Limit number of members 5 - 7 most efficient Rotate team manager Keep social function of team to a minimum |
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Theory Definition
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An idea or set of concepts that describe, organize or explain phenomenon
Provides definitions Describes relationships between significant concepts within the theory |
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Research Definition
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intended for use in such investigation and discovery
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Development Definition
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specified state of growth or advancement
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Human Communication is based on?
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Verbal, (auditory) non verbal, visual
Human beings create their “world” by coding experiences into manageable components that have meaning. Communication Requires commonality of meaning |
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Classification definition
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Simply stated, is the ordering of entities into groups or classes on the basis of their similarity
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Why was science created? And its importance?
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Human process of making sense of our human experience
We Needed a common language “True”, coherent, logically ordered Testable by research that ANY person can use and get the same result |
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How does Theory become Law?
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In science, theory is an all-inclusive explanation of a property that is supported by many facts gathered over time.
What accurately describes observations, contains only a few chance elements, and makes predictions of future observations Becomes foundation for knowledge |
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Ethical or Empirical Sciences vs. Applied Sciences?
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Ethical or Empirical =
explain the world as it is Math, physics, Chemistry Applied = explain what we create, understanding to ADAPT Nursing, aeronautics... |
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What is General Systems Theory (Von Bertalanffy) and Why is it Important?
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Places all components under study in to this frame work in order to isolate the elements, understand the relationships and fine tune the system and predict future events.
Relationship exists between the whole and its parts The whole is more than a sum of its parts A system is goal directed Systems have boundaries - open/closed An open system changes - evolves Set of parts connected to function as a whole for some purpose and through the interdependence of the parts. Input→Throughput→Output→Feedback→ My presence affects the situation?? Key in Roy Model Open Systems tend to adapt and change (Biology) Closed System - Light Switch Input – facilitate the adapting system = nursing intervention |
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What is Change Theory (Lewin) and Why is it Important?
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Adaptation: both a process and an outcome
A target system is in a steady state something shifts and the system adjusts in an effort to return to steady state Change in target occurs when there is an increase in # or intensity of Drivers and restrainers are constant , OR an increase in # or intensity of restrainers when drivers are constant Driving forces - facilitate the change Restraining forces - impede the change Target system- who/what needs to change Change process - occurs when there is an imbalance in either drivers or restrains Rigid, Fluid, Rigid Prepare for the change Assemble resources and strategies Assess all aspects of the existing system-gather data, activity target and environment Identify the drivers and restrainers Choose change agents and their roles Create an atmosphere supportive to the change: Induce guilt, create discomfort, Provide psychological safety. Either.. Strengthen Drivers or Weaken Restrainers KEY is ASSESSMENT |
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What is Human Needs Theory (Maslow) and Why is it Important?
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Human needs are organized in hierarchy of prepotency
Prepotency- higher needs emerge as lower ones are satisfied Needs do not disappear when the are satisfied, they decrease in priority Can emerge in a different order in different people Example: ABC's of respiration, safety, and then family Every human is unique and works through their need structure uniquely. It is also important to understand that at any time all the needs are within the individual, the one that is most important is the one not satisfied. Humans are very complex the theory states that the biologic drives for survival are intact for healthy people. This brings up a discussion r/t unhealthy. Example anorexia, the need to be in control (safety), replaces the need to eat. |
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What is Nursing Science?
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A coherent body of nursing knowledge composed of research findings and tested theories that direct or the discipline
We are applied Science, we do not aspire. |
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Nursing as an art?
Definition of art? |
Art: A collection of human activities, creations, and expressions that provoke the senses and emotions of an individual.
Art is a dialogue that forces interpretation. It is the result of human creative skill and its application. Art comes from human activity Art assists understanding A collection of nursing activities that understand and provoke the senses and emotions of an individual. It is the culmination of a creative nursing skill and its application. Nursing is skill; to practice is the art |
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Describe Nursing as a science?
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Science
A process of research and inquiry Focused on the problems and concerns of nursing Defines terms and identifies processes that create a body of empirical nursing knowledge Direct the performance of nursing actions Building Nursing science one needs to review what science is, how it functions for nursing, and how we build a body bf nursing knowledge that helps us to define and deliver nursing care. Developing a Theory of Nursing science forces in depth scrutiny of what is nursing. Theory building hopes to answer questions about nursing. So we can teach the next generation in a logical and systematic fashion |
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Describe Nursing as a body of knowledge?
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Collaborates with other professions
Is goal focused and outcome oriented Based on Research and evidence From the patient perspective it is irrelevant to argue if a selected behavior is nursing care or medical care. |
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Describe Philosophy of Nursing?
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Philosophy is the study of general problems concerning matters such as existence
Philosophy uses critical thinking and a systematic approach based on reasoned argument Philosophy of Nursing: A discussion of what is nursing and why nursing exists |
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Conceptual model for nursing definition
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a set of concepts or images that identify and relate the essential elements of nursing
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Environment
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in nursing, all that influences people and their health including physical surroundings
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Health
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In general, the individual's total well-being
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Holistic
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the philosophic assumption about people that refers to the physical, thinking, and feeling processes functioing together
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Model
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a description or analogy used to heelp visualize
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Knowledge
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In nursing, involves philosophic and scientific principles related to people
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Nursing
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A health care profession that focuses on the life processes and patterns of people with a commitment to promote full life
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Philosophic Assumptions
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the values and beliefs that are the foundation of nursing knowledge and practice
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Roy Adaptation Model
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She builds her theory on systems theory. She's an applied systems model.
She assumes that it is an OPEN systems structure, that it's complex, that it's holistic, and that there is an interdependence within every interaction within the human sphere. She says that, just like Maslow, humans have an integrity that they are moving towards. Foundation is that we are dealing with raw materials. Get it right the first time! |
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Lifespan of the General Nursing Theory?
Florence take on NT? |
Provides the foundation and definitions for the development of nursing knowledge.
The accumulation of nursing knowledge is based upon a combination of research from Nursing and related human research. Observe nursing, Describe nursing, Prescribe nursing with predictable results Grand = 3rd D Meta = biological system Mid Range = prevent illness Practice = immunizations In nursing we triangulate and incorporate many theories on different levels to create practice based behavior. Some pure theorists say this does not help to develop a “unique and selective theory of nursing”. It is where we have evolved to thus far. Florence Nightingale: Notes on nursing , What it is what it is not. Description to have charge of someone's health prescription Examples: “White” = clean environment, fresh air, wash Hand Hygiene = wash your hands Cheese and diet |
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What are mid range theories?
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Mid-range theories provide
Directions to practice; abstract enough to be scientifically interesting. |
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Vertivity (Roy) define
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Principle of human nature that affirms a common purposefulness of human existence, activity and reactivity for the common good and value and meaning of life. Goal direction
Assumption: Patient’s values and opinions are to be considered and respected. |
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Adaptive (Roy) define
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Adaptive: Human system has the capacity to adjust effectively to changes (adapt) in the environment and affects the environment. Promote survival, growth, reproduction & mastery.
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