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140 Cards in this Set
- Front
- Back
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a systematic rational method of providing nursing care for individuals, families, groups, and communities
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nursing process
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an active, organized, cognitive process used to carefully examine one's thinking and the thinking of others
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critical thinking
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What are the 5 steps of the nursing process?
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1. Assessment
2. Diagnostic Process (Analysis) 3. Plan 4. Implementation 5. Evaluation |
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the deliberate and systematic collection of data to determine a patient's current and past health status, functional status, and to determine the patient's past and present coping patterns
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assessment
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What is the purpose of the assessment (step 1 in the nursing process)?
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to establish an accurate data base about the patient's perceived needs, health problems, and responses to these problems
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What are the 2 parts of an assessment?
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1. Collect and verify accurate data from primary source (patient) and secondary sources (family/med record).
2. Analyze data as a basis for developing a plan of care |
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What are the 2 types of data?
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subjective
objective |
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includes decision-making steps, including gathering the assessment database, validating data for accuracy, analyzing and interpreting data, identifying patient needs, and formulating the nursing diagnoses
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diagnostic process (analysis) - step 2 of nursing process
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What are the 2 components of the diagnostic process?
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analysis of data for meaningfulness
formulation of nursing diagnoses from the meaningful data |
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What are the goals of the diagnostic process?
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1. To direct an individualized plan of care for the patient and family
2. To improve communication between nurses and other health care workers 3. To prioritize nursing goals, interventions, and outcomes for a patient |
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What are the 3 types of nursing diagnoses?
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1. Actual - what the patient actually has
2. Risk for - what the patient is at risk for 3. Wellness - what the patient is doing right |
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a tool that promotes critical thinking and helps the student nurse to organize complex patient data, process complex relationships, and achieve a holistic view of a patient's situation
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concept mapping
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What goes in the center of the concept map?
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the nursing diagnoses (Ex. diabetes, peripheral vascular disease, cellulitis)
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What goes around the outside of the concept map?
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subjective and objective data (Ex. pain, infection, impaired perfusion, immobility)
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provides direction for the selection and use of nursing interventions and provides focus for the evaluation of the interventions
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planning (step 3 of nursing process)
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Outcomes of the plan should be SMART--what does SMART stand for?
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Specific
Measurable Appropriate Realistic Timely |
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any treatment (based on clinical judgment and knowledge) that a nurse performs to enhance patient outcomes
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intervention
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Selecting interventions is part of which step in the nursing process?
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step 3 - planning
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What are the 2 types of interventions?
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direct (ex. turning patient, giving meds, feeding, bathing)
indirect (ex. writing care plans, charting, coordinating care with health team) |
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The nurse initiates and completes actions or interventions necessary for achieving goals and expected outcomes of nursing care.
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Implementation (step 4 of nursing process)
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provides guidelines for safe and compassionate care
guarantees the public that nurses adhere to professional practice standards |
code of ethics
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the study of moral issues as they relate to medical treatment and research
guides discourse about difficult issues that arise in healthcare |
bioethics
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the study of philosophical ideals of right and wrong behavior
the study of good conduct, character, and motives concerned with determining what is good or valuable for all people |
ethics
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a person's independence
an agreement to respect another's right to determine a course of action |
autonomy
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taking positive actions to help others
duty to do good: How can the client best be helped? major issue is "when to treat", quality of life Will treatment prolong suffering? |
beneficience
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the avoidance of harm or hurt
the nurse tries to balance the risks and benefits of a plan of care while striving to do the least harm possible |
nonmaleficence
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fairness
involves the allocation and rationing of health care services involves patient rights and access to care |
justice
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the agreement to keep promises
the obligation to follow through with care offered to clients |
fidelity
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the ability to answer for one's own actions
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accountablity
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reliability and dependability
an ability to distinguish between right and wrong duty to perform actions well and thoroughly |
responsibility
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the rights and privileges of a client for protection of privacy
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confidentiality
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accuracy and conformity to truth
guides nurses to practice truthfulness |
veracity
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a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior
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value
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What are some of the modes of value formation?
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parenting
religious groups government school individual experiences |
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the process of self discovery that helps a person gain insight into his values
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value clarification
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What are the 3 steps of value clarification?
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1. Choosing one's beliefs/behaviors
2. Prizing one's beliefs/behaviors 3. Acting on one's beliefs |
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adopted as a result of the social setting in which one lives
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cultural values
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the belief that one's own culture is superior
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ethnocentrism
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defines actions as right/wrong based on fidelity, truthfulness, and justice, not on the consequences of actions
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deontology
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the value of something is determined by its usefulness (consequences)
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utilitarianism/consequentialism
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Processing an ethical dilemma differs from the nursing process as:
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it requires negotiation of differences, incorporation of conflicting ideas, and an effort to respect differences of opinion
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To distinguish an ethical problem from questions of procedure, legality, or medical diagnosis, the nurse must decide whether the problem has one or more of the following characteristics:
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1. Cannot be resolved solely through a review of scientific data
2. It is perplexing 3. The answer has relevence for several areas of human concern |
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What are the 7 steps of processing an ethical dilemma?
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1. Decide if it is really an ethical dilemma
2. Gather pertinent info 3. Examine/determine your own values in the issue 4. Verbalize the problem 5. Consider possible courses of action 6. Negotiate the outcome 7. Evaluate the action |
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What are the functions of ethics committees?
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look at death that occur in hospital
decide if doctor is being ethical determine if research is ethical |
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Who wrote and updated the 9 provisions of the nursing code of ethics?
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ANA (American Nurses Association)
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In the 1920s, concerns about the cost and maldistribution of medical care resulted in the formation of:
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the Committee on the Costs of Medical Care (under President Truman)
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Individuals (consumers) ultimately bear the burden of paying for increasing health care costs through--
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higher taxes
reduced wages higher product costs |
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When was Medicare enacted and what was it part of?
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1965
Social Security Act |
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Who is eligible for Medicare?
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people 65 years or older
people with end-stage renal disease people under 65 with a disability for minimum of 2 yrs |
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What were the original 2 parts of Medicare?
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Part A. Hospital Insurance (HI) - everyone gets this (doesn't cost $)
Part B. Medical Insurance (SMI) - must pay premium to get this, covers more than part A |
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What is Medicare part C?
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established by Balanced Budget Act of 1997
expanded option for beneficiaries to enroll in private managed care plans |
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What is Medicare part D?
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prescription drug benefits (created in 2003)
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an individual who qualifies for Medicare, plus receives supplemental coverage under Medicaid
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dual eligible
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What is the current prediction about the Medicare crisis?
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it is solvent until 2020
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What kind of payment system did the U.S. have before 1982?
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retrospective:
health care institutions were paid for their "reasonable and necessary charges" billing was submitted AFTER services were provided and institution was paid |
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What kind of payment system has the U.S. had since 1982?
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prospective payment system:
reimbursement is made according to a predetermined classification system (DRGs) |
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What are the notable outcomes of the prospective payment system (PPS)?
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earlier discharge of clients
decline in # of admissions increased # and type of outpatient services limited delivery of services increased emphasis on cost |
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When was Medicaid enacted?
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1965 (part of SSA with Medicare)
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provides federal matching funds to states to help pay the cost of medical care for low income persons (medically indigent)
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Medicaid
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Who administers Medicare?
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the Centers for Medicare and Medicaid (CMS)
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Who administers Medicaid?
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each state Medicaid office
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Who is eligible for Medicaid?
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medically indigent
disabled for over 1 year |
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What does Medicaid pay for?
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premiums for Medicare SMI (Part B)
deductibles for Medicare HI (Part A) prescription meds eyeglasses dental services skilled nursing care durable medical equipment |
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provides funds to states to expand Medicaid eligibility to a greater number of uninsured children
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State Children's Health Insurance Program (SCHIP)
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Does Medicaid cover nursing homes or assisted living facilities?
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does cover nursing homes
doesn't cover assisted living |
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What are the 2 types of private health insurance?
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Not-for-profit (BCBS)
For-profit (Metropolitan Life, Aetna, Travelers) |
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a philosophy of health care that integrates the financing, delivery, and use of care
its goal is to provide cost-effective, quality care and improved outcomes for clients |
managed care
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What are the 3 types of managed care arrangements?
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Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs) Case Management |
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the exchange of thoughts, ideas, or information
a dynamic process that is a primary instrument through which change occurs in nursing situations |
communication
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What are the 3 phases of communication in the nurse-client relationship?
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orientation phase (introduction)
working phase (learn about them) termination phase (end the relationship) |
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communication that occurs within an individual (inner thoughts, feelings, self-concept)
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intrapersonal
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one-to-one interaction that usually occurs face to face
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interpersonal communication
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interaction that occurs within a person's spiritual domain (prayer, meditation, rituals)
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transpersonal communication
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interaction between 2 or more persons meeting together
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small-group communication
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interaction with an audience
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public communication
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motivation (stimulus) that initiates communication
Ex. a cool phone |
referent
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person who delivers the message
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sender
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person who receives the message
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receiver
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the content of the communication
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message
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the means of conveying and receiving messages (auditory, visual, tactile)
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channels
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the message returned by the receiver
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feedback
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What are some examples of symbolic communication?
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art
music child's play drawings symptoms of illness |
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the verbal and non-verbal aspects of communication match and reinforce each other
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congruent communication
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the words and non-verbal communication do not match
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incongruent communication
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What are the 4 zones of personal space and touch?
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intimate (0-18 inches)
personal (18 inches to 4 ft) social public |
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a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity
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health
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What are the 4 factors that affect health?
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human biology (genetics)
environment (carcinogens) lifestyle (diet, exercise) health care (access to it) |
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activities that protect good health and take people beyond their present level of wellness
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health promotion
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teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self-responsibility
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wellness education
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actions that precede disease or dysfunction and are designed to reduce the incidence of disease by promoting health and preventing disease from developing
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primary prevention
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What are some examples of primary prevention?
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health education about nutrition, exercise, and hygiene
genetic screening immunizations |
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focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening condition
tries to slow or stop disease activities directed at diagnosis and prompt intervention |
secondary prevention
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What are some examples of secondary prevention?
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screening procedures
case finding selected examinations treatment to arrest disease process actions to limit diability |
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occurs when a defect or disability is permanent and irreversible
involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications, further disability, and deterioration |
tertiary prevention
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What are some examples of tertiary prevention?
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retaining and educating to maximize the use of remaining capacities, selective placement, and modifying environments
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any situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident
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risk factor
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What are the 5 stages of health behavior change?
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precontemplation
contemplation preparation action maintenance |
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a state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with previous experience
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illness
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how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system
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illness behavior
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consists of laws written and enacted by legislative bodies
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statutory law
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describe and define the legal boundaries of nursing practice within each state (ex. schedule of fees, licensure procedures)
written by state boards of nursing |
Nurse Practice Acts
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What are the 2 divisions of statutory law?
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criminal law
civil law |
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prevents harm to society and provides punishment for crimes
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criminal law
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generally deals with the violation of one's individual rights by another individual
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civil law
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laws created by administrative bodies such as the state boards of nursing when they pass rules and regulations
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regulatory or administrative law
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laws created by judicial decisions made in courts when individual legal cases are decided
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common law
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legal guidelines for nursing practice
the level of conduct for which a nurse is held accountable ex. must use sterile technique when putting in a catheter |
standards of care
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Who/what defines standards of care?
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Nurse Practice Acts
State Board of Nursing Professional organizations Federal/state laws regulating hospitals and other health care institutions hospital policies and procedures |
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a civil wrong made against a person or property
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tort
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What are the 2 types of torts?
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intentional (meant to do harm)
unintentional (accidental or negligent behavior) |
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unjustifiable attempt to touch another OR the threat to touch
type of intentional tort |
assault
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actual harmful or unwarranted contact with another person without his/her consent
type of intentional tort |
battery
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a violation of a person's right to protection against unreasonable and unwarranted interference with one's personal life
type of intentional tort |
invasion of privacy
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spoken or written FALSE information that is harmful to a person's reputation by diminishing the esteem, respect, good will or confidence that others have for this person
type of intentional tort |
defamation of character
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spoken defamation of character
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slander
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written defamation of character
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libel
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conduct that falls below the standard of care
type of unintentional tort (most common in nursing) |
negligence
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the omission of an act that a "reasonable and prudent person" would perform in a similar situation
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malpractice (professional negligence)
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law specifically designed to protect healthcare providers who render care during emergency situations
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Good Samaritan Act
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the single most frequently used piece of evidence in a malpractice suit
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medical record
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voluntary permission by a client or the client's proxy to carry out a procedure
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informed consent
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What do you do if you make an error on a chart?
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Take a pen and mark one line through it and write ERROR above it
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transferring responsibility for the performance of an activity or task while retaining accountability for the outcome
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delegation
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What are the 5 rights of delegation?
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right task
right circumstance right person right direction/communication right supervision/evaluation |
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a universal phenomenon that influences that ways in which people think, feel, and behave in relation to other people
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caring
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Which theorist do these ideas belong to?
- Caring is the essence and central, unifying and dominant domain of nursing and health - Care is an essential need, necessary for health and survival of all individuals - Even though caring is universal, the expressions, processes, and patterns of caring vary among cultures |
Madeleine Leininger
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Which theorist do these ideas belong to?
- Caring, as a moral ideal, provides the stance from which one intervenes as a nurse - Transpersonal caring looks for deeper sources of inner healing to protect, enhance, and preserve a person's dignity, humanity, wholeness, and inner harmony - Both the nurse and client are influenced by the relationship |
Jean Watson
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Which theorist do these ideas belong to:
- Caring is a central nursing phenomenon, but not unique to nursing - It consists of 5 processes: knowing, being with, doing for, enabling, maintaining belief |
Kristy Swanson
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What did Kristy Swanson say were the 5 processes of caring?
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knowing
being with doing for enabling maintaining belief |
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an experience a person is exposed to through a stimulus or stressor
the appraisal or perception of a stressor |
stress
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condition in which stress overwhelms the ability to cope
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crisis
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condition in which stress exists beyond the duration of the stressor
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trauma
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controls heart rate, blood pressure, and respiration
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medulla oblongata
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neurons in the brain stem and spinal cord that monitor sensory and motor functions and increase LOC
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reticular formation
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releases hormones that respond to stress
attached to the hypothalamus |
pituitary gland
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describes a 3 stage reaction to stress
originally described by Hans De Solye in the 1920s |
General Adaptation Syndrome
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What are the 3 stages of the general adaptation syndrome?
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alarm reaction
stage of resistance stage of exhaustion |
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regulate emotional distress and give a person protection from anxiety and stress
developed by Freud |
ego defensive mechanisms (compensation, conversion, denial, displacement, identification, dissociation, regression)
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the name given to a cluster of symptoms often seen in trauma survivors
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post traumatic stress disorder (PTSD)
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based on the concepts of stress and reaction to stress
nursing is responsible for developing interventions to prevent or reduce stressors on the client every person has a line of defense against stressors, when the line of defense is broken then disease can result |
Neuman System Model
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