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195 Cards in this Set
- Front
- Back
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STEREOTYPE
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A fixed or conventional conception of a person or group held by a number of people that allows for no individuality.
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COMPETENCY OUTCOMES
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The results, or end products, of planned study and experience that are focused on specific abilities required for practice.
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CONTEMPORARY ISSUES
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The problems, questions, and concerns that are current for the present time or era.
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EDUCATIONAL MOBILITY
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The progressive movement from one type or level of education to another, often based on flexible, self-directed, or advanced placement options. Ex. are progression from diploma prep. to academ ic degree (RN 2 BSN, or BSN 2 MSN).
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EDUCATION TRENDS
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Shifts in conditions and concerns that emerge from and influence various aspects of society; broad changed in the US and the world that influence the education and practice of nurses and others.
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PERFORMANCE-BASED ASSESSMENT
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Evaluation of abilities based on objective demonstration of specific required competencies rather than on evaluation of knowledge about those abilities. This may include performance in actual or simulated situations... r/t critical thinking, problem solving, planning, writing, analysis, etc.
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ACCREDITATION
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Voluntary process by which schools of nursing are approved to conduct nursing.
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APN: ADVANCED PRACTICE NURSE
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Legal title for nurses prepared by education and competence to perform independent practice.
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ANA: AMERICAN NURSES ASSOCIATION
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Professional organization that represents all registered nurses.
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CERTIFICATION
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Process by which nurses are recognized for advanced education and competence.
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COMMISSION ON COLLEGIATE NURSING EDUCATION (CCNE)
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A subsidiary of the American Association of Colleges of Nursing with responsibility for accrediting Bachelors and higher degree programs.
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AMERICAN NURSES CREDENTIALING CENTER (ANCC)
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An independent agency of the American Nurses Association that conducts certification examinations and certifies APNs
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COMPACT STATE
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A term of law. In the context of the nurse licensure compact, a state that has established an agreement with other states allowing nurses to practice within the state without an additional license. The interstate compacts are enacted by state legislatures.
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CONTINUED COMPETENCY PROGRAM
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A variety of initiatives to ensure nurses' knowledge, skills, and expertise beyond initial licensure.
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GRANDFATHERED
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Statutory process by which previously licensed persons are included without further action in revisions or additions in NPActs.
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INTERNATIONAL COUNCIL OF NURSING (ICN)
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Professional organization that represents nurses in countries around the world.
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LICENSURE BY ENDORSEMENT
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The original program whereby nurses licensed in one state seek licensure in another without repeat examinations. The requirements are included in state NPActs or accompanying rules and regulations.
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MANDATORY CONTINUING EDUCATION
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Educational requirements imposed by individual states for renewal of a license.
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NUTUAL RECOGNITION OF NURSING
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Program developed by the National Council of State Boards of Nursing, Inc. The nurse licensure compact program establishes interstate compacts so that nurses licensed in one jurisdiction may practice in other compact states without duplicate licensure.
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NATIONAL COUNCIL OF STATE BOARDS OF NURSING (NCSBN)
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Organization whose membership consists of the board of nursing of each state or territory.
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NATIONAL LEAGUE OF NURSING (NLN)
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Professional organization whose members represent multiple disciplines. The national league conducts many types of programs, including accrediting nursing ed. programs.
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NURSING PRACTICE ACTS
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Statute in each state and territory that regulates the practice of nursing.
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STATE BOARD OF NURSING
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Appointed board within each state charged with responsibility to administer the Nursing Practice Act of that state.
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SUNSET LEGISLATION
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Statutes that provide for revocation of laws if not reviewed and renewed within a specified time line.
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EFFECTIVENESS
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Production of a desired outcome; doing the right thing correctly to achieve the expected result.
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EFFICIENCY
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The extent to which resources, such as energy, time and money, are used to produce the intended result.
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GDP
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The measure of the total value of goods and services produced within a country; the most comprehensive overall measure of economic output; provides key insight to the driving forces of the economy.
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MARGINAL
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An economic term that refers to a small or insignificant change in some variable (eg. the number of tests performed).
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PROSPECTIVE PAYMENT SYSTEM
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A method of reimbursing health care providers in which the total amount of payment for care is predetermined based on the pts diagnosis; provides a "set price per diagnosis" system which contrasts the "fee for service" system; encourages efficiency in services since providers are reimbursed at a set level.
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PROVIDER
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An individual (such as a physician) or an organization that receives reimbursement for providing health care services.
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RETROSPECTIVE PAYMENT SYSTEM
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A method of reimbursing health care providers in which professional services are rendered and charges are billed based on each individual service provided; "fee-for-service" system, which encourages overuse of services because more services means more revenue.
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SINGLE PAYER SYSTEM
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A method of reimbursement where one payer, usually the govt. pays all health care expenses for citizens, funded by taxes. All decisions regarding treatment, drugs, services are made by govt. "universal health care" offers everyone insurance coverage.
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THIRD PARTY PAYER
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An organization other than the patient and supplier (hospital/doctor) that assumes responsibility for payment (insurance company).
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ACCULTURATION
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The process of becoming adapted to a new or different culture.
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ASSIMILATION
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The cultural absorption of a minority group into the main cultural body.
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BICULTURALISM
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Combining two distinct cultures in a single region.
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CULTURE
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Shared values, beliefs, and practices of a particular group of people that are transmitted from one generation to the next and are identified as patterns that guide thinking and action.
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ENCULTURATION
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Adaptation to the prevailing cultural patters in society
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ETHNICITY
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Affiliation resulting from shared linguistic, racial, or cultural background.
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ETHNOCENTRISM
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Believing that one's own ethnic group, culture, or nation is best.
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MARGINALIZED POPULATION
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A subgroup of the population that tends to be hidden, overlooked, or on the outer edge.
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MINORITY
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An ethnic group smaller than the majority group.
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PREJUDICE
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Preconceived, deeply held, usually negative, judgement formed about other groups.
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STEREOTYPING
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Assigning certain beliefs and behaviors to groups without recognizing individuality.
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TRANSCULTURALISM
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Being grounded in one's own culture, but having the skills to be able to work in a multicultural environment.
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WORLDVIEW
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Perspective shared by a cultural group of general views of relationships within the universe. These broad views influence health and illness beliefs.
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ACCOUNTABILITY
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Being responsible for one's actions; a sense of duty in performing nursing tasks and activities.
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ADVANCE DIRECTIVES
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Written or verbal instructions created by the patient describing specific wishes without medical care in the event he or she becomes incapacitated or incompetent. Ex. are living wills and durable power of attorney.
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ADVERSE EVENT
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An injury caused by medical management rather than the pt's underlying condition. Attributable to error in preventable adverse event.
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CASE LAW
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Body of written opinions created by judges in federal and state appellate cases; also known as judge-made law and common law.
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CIVIL LAW
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Category of law (tort law) that deals with conduct considered unacceptable. It's based on societal expectations regarding interpersonal conduct. ex: negligence, malpractice, assault, battery.
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COMMON LAW
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Law that is created through the decision of judges as opposed to laws enacted by legislative bodies.
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COMPARATIVE NEGLIGENCE
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Type of liability in which damages may be apportioned among two ore more defendants in a malpractice case. The extent of liability depends on defendant's relative contribution to the pt's injury.
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DAMAGES
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Monetary compensation the court orders pain to a person who has sustained a loss or injury to his/her person or property through the misconduct of another.
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DEFENDANT
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The individual who is named in a person's complaint and named as responsible for injury.
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DISCLOSURE
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A process in which the pt's primary provider gives the pt, and maybe family members, complete info. about unanticipated adverse outcomes of treatment and care.
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DURABLE POWER OF ATTORNEY FOR HEALTH CARE
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An instrument that authorizes another person to act as one's agent in decisions regarding health care if the person becomes incompetent to make his or her own decisions.
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ERROR
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A failure of planned action to be completed as intended or the use of a wrong plan to achieve a specific aim.
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IMMUNITY
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Legal doctrine by which a person is protected from a lawsuit for negligent acts or an institution is protected from a suit for the negligent acts of its employees.
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LIABILITY
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Being legally responsible for harm caused to another person or property as a result of one's actions; compensation for harm normally is paid in monetary damages.
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LICENSING LAWS
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Laws that establish the qualifications for obtaining and maintaining a license to perform particular services. Persons and institutions may be required to obtain a license to provide particular health care services.
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MALPRACTICE
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Failure of a professional to meet the standard of conduct that a reasonable and prudent member of his or her profession would exercise in similar circumstances that results in harm. The misconduct is unintentional. Doing something bad.
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NEGLIGENCE
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Failure to act in a manner that an ordinary, prudent person would act in similar circumstances, resulting in harm. The failure to act is unintentional. Not doing something good.
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PLAINTIFF
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The complaining person in a lawsuit; person who claims he or she was injured.
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RES ISPA LOQUITUR
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Legal doctrine applicable to cases in which the provider had exclusive control of events that resulted in the pt's injury. The injury would not have occurred ordinary without a negligent act; derived from "the thing speaks for itself."
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RESPONDENT SUPERIOR
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Legal doctrine that holds an employer indirectly responsible for the negligent acts of employees carried out within the scope of employment; derived from "let the master answer."
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RISK MANAGEMENT
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Process of IDing, analyzing, and controlling risks for pts. Involves human factor and incident analysis, changes in systems operations, and loss control and prevention.
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SENTINEL EVENT
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As defined by the joint commission, an unintended adverse outcome that results in death, paralysis, coma or perm. loss of function.
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STANDARD OF CARE
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In civil cases, the legal criteria against which the nurse's conduct is compared to determine whether a negligent act or malpractice occurred.
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STATUTE OR STATUTORY LAW
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Law enacted by a legislative body; separate from judge-made or common law.
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TORT
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Civil wrong or injury committed by one person against another person or property. Two types: intentional and unintentional.
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VICARIOUS LIABILITY
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Legal doctrine in which a person or institution is liable for the negligent acts of another because of a special relationship between the two parties; a substituted liability.
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ACCOUNTABILITY
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An ethical duty stating that one should be answerable legally, morally, ethically, or socially.
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AUTONOMY
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Personal freedom and right to make choices.
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BENEFICENCE
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An ethical principle stating that one should do good and prevent or avoid doing harm.
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BIOETHICS
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The study of ethical problems resulting from scientific advances.
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CODE OF ETHICS
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Set of statements encompassing rules that apply to people in professional roles.
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DEONTOLOGY
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An ethical theory stating that moral rule is binding.
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ETHICS
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Science or study of moral values.
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NONMALEFICENCE
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An ethical principle stating the duty not to inflict harm.
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UTILITARIANISM
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An ethical theory stating that the best decision is one that brings about the greatest good for the most people.
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VALUES
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Ideas of life, customs, and ways of behaving that society regards as desirable.
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VERACITY
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An ethical duty to tell the truth.
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CONSTITUENT
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A citizen who has the opportunity to vote for candidates in elections for representation of the local, state, and federal government level.
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CMA: CONSTITUENT MEMBER ASSOCIATION
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The state professional organizational member of the ANA that represents all nurses at the state level (formerly state nurses association).
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GRASSROOTS LOBBYING
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Advocacy by individual constituents in support of an organization's official position related to a polity issue.
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HEALTH POLICY
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A course of action taken by govt. or health care org. that results in a health outcome. Private health policy is made my hospitals or org. but a public health policy is made by sate, local or federal legislation, regulation, or court rulings.
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LOBBYING
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An act of persuading or otherwise attempting to educate and convince policy-makers to comply with a request, support a particular position on an issue, or follow a particular course of action.
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PLATFORM
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The statement of principles and policies of a political party, candidate, or elected official.
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POLICYMAKER
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Local, state, or congressional elected official who can propose legislation, regulations, or programs that can become actualized as public law.
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REGULATION
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Rules used to implement legislation and translate concepts into legal, implementable action.
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STAKEHOLDERS
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Individuals, groups, or organizations who have a vested interest in and may be affected by policy decisions and actions being taken and who may attempt to influence those decisions and actions.
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ACTIVE COMMUNICATION
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A participatory form of communication that promotes change.
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ACTIVE LISTENING
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The process of hearing what others are saying with a sense of seriousness and discrimination.
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AGGRESSIVE COMMUNICATION
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A manner of communicating that limits the focus on or understanding of the opinions, values, or beliefs of others.
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ASSERTIVE COMMUNICATION
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A form of communication that enables a person to act in his/her own best interest without denying or infringing upon the rights of others.
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BLOCKING
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Obstructing communication through noncommittal answers, generalization, or other techniques that hamper continued interaction.
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COMMUNICATION
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A process of relaying information between or among people by the use of words, letters, symbols, or body language.
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CONFLICT
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An experience in which there is simultaneous arousal of two or more incompatible motives.
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DECODE
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A process whereby the receiver takes the message and interprets it's meaning.
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EMPATHY
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An attempt to experience another person's point of view without losing one's own identity.
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ENCODE
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A process of translating an idea already conceived into a message suitable for transmission.
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EQUALITY
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An attitude that relays acceptance and approval of another person.
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FEEDBACK
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Response from the receiver, which can be verbal or nonverbal.
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FILTRATION
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Unconscious exclusion of extraneous stimuli.
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INFORMATION
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The data that is meaningful and alters the receiver's understanding.
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INTERPRETATION
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Receiver's understanding of the meaning of the communication.
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NEGATIVE COMMUNICATION TECHNIQUES
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Behaviors that block or impair effective communication.
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NONASSERTIVE COMMUNICATION
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Communicating in a timid and reserved manner resulting in limited concern for one's own rights regardless of the situation.
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NONVERBAL COMMUNICATION
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Unspoken cues (intentional or unintentional) from the communicant, such as body positioning, facial expression, or lack of attention.
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OPENNESS
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An attitude of willingness to self-disclose, react honestly to the messages of others, and own one's feelings and thoughts.
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PASSIVE COMMUNICATION
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A form of communication in which the individual fails to say what is meant.
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PERCEPTION
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The manner in which one sees reality.
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POSITIVE COMMUNICATION TECHNIQUES
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Behaviors that enhance effective communication.
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RECEIVER
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The destination for or receptor of a message.
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SENDER
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Anyone who wishes to convey an idea or concept to others, to seek information, or to express a thought or emotion.
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SUPPORTIVENESS
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The concern that is fostered by being descriptive rather than evaluative and provisional rather than certain.
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Describe the image of nursing in art, media, and literature over time
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6th century to the 1800’s: Untrained servants, soldiers, women of religious orders, or wealthy people performing acts of Christianity; WW1: nurses were portrayed as heroic; ‘36 the white angel, Florence nightingale: holy vocation, professional credentials, career for women. ‘60s One Flew Over… Nurse Ratched: punished patients; 1970s sexual revolution: Hot Lips Hoolihan; ‘80s-‘90s: knowledgeable, nonjudgmental caregiver (focused on caring).
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Suggest strategies that would enhance the image of nursing
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Sense of professional status, belief that they made a difference, pride in their profession. Increased professionalism and knowledge for nurses. When nursing practice is considered knowledge work where nursing judgment counts, other images fall away.
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Create an individualized plan to promote a positive image of nursing in practice
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Increase nurse knowledge of clinical practice, law, change nurse-physician interactions: increase in the value of nursing judgment.
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Integrate knowledge of 10 current trends and issues in society and health care into a more holistic perception of their influence on nursing, nursing education, students, faculty and practitioners
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Nurses are expected to have broad range of technical and professional skills, integrate, think critically, work collaboratively with other health care workers, know most current information, more of it, faster, in face of an aging population, multicultural population, in different areas of health care, who all require more care with a shortage of nurses. Also, ethical issues and how nurses deal with them have an impact, and there is an increase in personal responsibility and professional expectations. High stress.
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Practical or vocational nurse program: prepares LVN or LPN license
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High schools, hospitals, technical schools (9-12 mo): basic technical bedside care; hospitals, nursing homes, home care, offices in LPN positions. Usually required to work under RN.
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Hospital diploma program: prepares for RN license
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hospitals, some in conj. With colleges (2-3 yr): basic RN positions; hospitals and agency care.
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Associate degree in nursing prepares for RN
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Community and junior colleges (2 yr): basic technical care in RN positions, primarily in institutions.
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BSN prepares for RN
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Colleges and uni (2 -4 yr): basic professional practice as RN; mgmt, community and public health, prep. 4 grad school. Believed that nurses are better when they get solid foundation in arts and sciences.
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MSN
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Universities (1 -2 yr): Advanced clinical practice, mgmt, education, and leadership. Expanded scope of practice for practitioners. Intensive classes at some places, and more flexible at others: can get dual major programs.
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PhD, DSN, DNSc, DNP
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Universities (varies): Advanced nursing for research, clinical practice, and leadership positions.
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10 major trends that affect nursing
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rapid knowledge expansion: increase in technology; practice-based competency outcomes and evidence based content; performance based competency learning and objective assessment methods; sociodemographics, cultural diversity, economic and political changes and global issues; community focused, interdisciplinary approaches; consumer oriented care, engagement, safety and privacy; ethics and bioethics; increase in nursing shortage and faculty; disasters, violence and terrorism; increase professional and personal responsibility.
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Differentiate among various types of conventional, mobility, and new nursing education programs and the issues associated with them.
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Mobility programs are: LPN, LVN, AND, BSN, MSN, doctoral. Issues are: issues of diversity, flexibility, and distance delivery in education. Almost all use electronic Internet based courses: does not require attendance, makes degrees accessible. Nursing shortage causes educators to streamline RN to BSN programs. Mobility is influenced by changes in social, political, financial, and philosophical trends, use of communication and technology, and success of past experiences. Shortage has made more schools flexible.
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Explain the development of licensure requirements in the US
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There was a registry of nurses enacted by nightingale. As programs proliferated variations developed based on needs of hospitals, and so another system was developed to distinguish trained from lesser trained. To ensure safety standards became necessary because of the variation in programs. In 1901 International Council of Nurses passed resolution for state examine and license of nurses, although they were voluntary. Nurses still not required to be registered. A minimum of 2 yrs training for nurses became standard under permissive licensure. 1923 all states had examinations for licensure, although each state varied in exams. Nursing practice acts were developed to fix that. 1947 licensure became required for first time. 1982 NCLEX-RN was developed.
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Analyze the various components of the NPA
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Two purposes: protect health and safety of citizen in jurisdiction AND to protect title of RN. It contains the rules and regulations. NPA RULES define scope of nursing practice, describe requirements and procedures for nursing licensure, include requirements and information necessary to renew license, has information on mandatory continuing education requirements. NPA REGULATES board of nurses to administer NPA.
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Discuss mutual recognition of nursing practice and identify nurse licensure compact states
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Most nurses are required to apply for licensure in each state, but because of increased mobility of nurses, state boards have recognized need to provide practicing nurses with endorsement of their initial license. States: AZ, AR, CO, DEL, IDAHO, IOWA, KT, MAINE, MD, MI, NEBRASKA, NH, NM, NC, ND, RI, SC, SD, TN, TX UT, VIRGINIA, WI.
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Describe the development of certification requirements for advanced practice
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Certification recognizes excellence in practice, whereas licensure establishes minimal levels of practice. Licensure is granted by legislation, certification is awarded by nongovernmental agencies. Certification began as a voluntary effort controlled by nursing organizations, and state agencies were not involved in credentialing process (still the case). However, nurse practice acts contain provisions requiring certification in regulation of APNs.
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Identify requirements for certification for advanced practice in different specialties.
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Exam requirements, education, experience. Also, state boards for legal requirements to practice in different jurisdictions. Nurse should develop a plan of action to complete requirements of agencies in expanded role.
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Current issues in certification
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Changing educational requirements for licensure and relicensure. Health care env. Changes, and so too does scope of practice and independence of ANPs. APNs are charting new territory: reimbursement for nursing services.
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FEE FOR SERVICE/ INDEMNITY PLAN
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Member pays premium for fixed percentage of expenses; includes deductible and co-payment; allows member to choose physician; may cover usual or reasonable and customary charges for tx and servies
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PPO (PREFERRED PROVIDER ORGANIZATION)
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Member pays a premium for fixed percentage of expense covered; includes deductible and copay; may select DR but pays less for DR on preferred list; may or may not have preventative care
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POS (POINT OF SERVICE)
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Offered by HMO or FFS; Allows use of providers outside plan's preferred list, but requires higher premiums and copays for service.
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HMO (HEALTH MANAGEMENT ORG)
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Member pays premium; fixed copay; must select pcp approved by HMO;must be referred for tx, specialists by pcp; out of netowrk must be preapproved for payment;may refuse to pay for services not recommended; encourages use of preventative care.
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MEDICARE
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Federal health insurance plan for Americans 65 and older; ct must be eligible for ss; part a covers hospital stays; part b requires payment of premium and covers DR services and supplies; carries a prescription drug benefit.
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MEDICAID
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Health care for low income or disabled or families with dependent children; fed program is managed by each state for eligibility and scope of services.
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TRICARE: MILITARY HEALTH INSURANCE
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civilian health and medical health insurance program for military spouses, dependents, and beneficiaries; program offered through military health services system.
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Analyze major factors that have influenced health care access and financing since the middle of the 20th century.
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Physician’s role as being primarily responsible for health care decision making; the broad objective of providing the “best” possible care to everyone; The rapid increasing sophistication and cost of medical technology; The economic incentives and the fee for service payment method that encouraged over use of services. (ex. Drs decided what services a pt needed in a fee for service payment system driven by “best possible care for all pts: lack of consciousness)
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Analyze the relationship between market issues and health care resource allocation.
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Due to Medicare and Medicaid the “full” cost of care was hidden, because taxpayers and employers were subsidizing cost. Because providers had no incentive to contain costs, “perverse economic incentives” were created which providers received more income for using more services. Medicare cost increased in early 80s because of growing elderly population, increased medical usage, and high inflation. The rapid growth of Medicare expenditures was major factor in federal budget deficit, causing reworking of Medicare payment system which led to how govt. and private insurance companies paid for health care. Rising health care costs inspired shift from fee for service reimbursement toward prospective payment system based on diagnosis related groups.
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Integrate knowledge of health care resources, access, and financing into managing professional nursing care.
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The regulated market system aspect for health care includes requirements of minimal nurse staffing in long term care facilities, laws regarding disposal of medical waste, and regulations affecting the conduct of medical labs. Additionally, health care providers become an “agent” of the pt because provider is in care of decisions: nurse can help educate pt on prices of services provided, and knowledge of information r/t diagnosis, and discourage overuse of treatment options (catheters?) … basically managing cost effective care.
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Critique the relationship between contemporary economic issues and trends and professional nursing practice.
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Many aspects of health care are economically and politically driven. It’s important to nurses because rules of payment are a reflection of value society places on health care services; policy influences public’s openness to services from NP; providers build job opportunities based on payment sources; payment modes determine if particular nursing role will be reimbursed.
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CARE COORDINATION
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one way to decrease duplication of services and reduce wasted health care resources. employs case mgmt and integration of services. changes in health care require nurses to understand principles of financial and resource mgmt and take leadership role to ensure effectiveness.
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CASE MANAGEMENT
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offers nurses opportunity to demonstrate cost effectiveness by ensuring pts get effective treatment in approp. level of care. Nurses must understand structure and process of health care industry, and bring critical thinking skills and pt advocacy.
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DISEASE MANAGEMENT
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Designed to manage and improve health status of pt population over course of dz. Nurses can impact effectiveness and efficiency of dz mgmt.
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OUTCOMES MANAGEMENT
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Nurses should demonstrate efficiency of care with measurable, effective outcomes. Nurse should know cost, and how pt outcomes can be affectively achieved with that in mind (minimizing resources).
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Incorporate fundamental laws and statutory regulations that establish the pt’s right to self determination in health care setting.
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The federal statute of the pt self determination act gives right to power of attorney for health care and living wills and right to die with dignity.
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Distinguish between intentional and unintentional torts in relation to nursing practice
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Unintentional tort is an unintended wrong against another, ie negligence or malpractice. An intentional tort means that there was intent to cause harm, or intentionally performing the act that caused the pt’s harm: assault, battery, defamation of character, false imprisonment, invasion of privacy, intentional infliction of emotional distress.
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Outline the essential elements that must be proven to prove a claim of negligence or malpractice.
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Nurse owed pt a special duty of care based on established nurse-pt relationship; the nurse has breached his/her duty to pt; actual harm or damage is suffered by pt; there is proximate cause or causal connection between breach in standard of care by nurse and pt injury.
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Analyze relationship between accountability and liability for one’s actions in professional nursing practice
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Liability means that nurse assumes responsibility for pt harm that is result of his or her negligent act: nurse cannot be relieved of personal liability by another professional by saying “don’t worry, I’ll take responsibility.” Accountability is when nurse is responsible for his/her actions
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Differentiate among 3 major categories of law on which nursing practice is established and governed.
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Statutory law: laws that are written by legislative bodies, such as congress or state legislatures. Ex. EMTALA and HIPAA are federal law; NPA are state law. Common law: is created through cases heard and decided in federal and sate appellate courts. These opinions eventually contribute to the expected standard of nursing conduct. Ex. “affirmative duty” or duty to prevent harm is common law. Civil law: deals with torts, or civil wrong or injury. Ex. Are negligence and malpractice.
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Integrate knowledge of demographic and sociocultural variations into culturally competent professional nursing care.
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More illness is seen in impoverished people than wealthy ones, and the majority of impoverished people are minority. Violence is more the result of poverty than race, but because most impoverished people are minority, there is more violence among minority. This means we need diversity in health care. There is a lack of ethnic representation in nurses, and limited cultural knowledge.
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Critique education, practice, and research issues that influence culturally competent care.
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Programs must have retention as their primary focus, because there is no point in recruiting minorities into nursing and not helping them succeed. Raising consciousness about the issues surrounding diversity in the workplace. Mentoring with nurses who have been trained in cross-cultural care. And the use of consultation that promote culturally competent care.
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Integrate respect for differences in beliefs and values of others as a critical component of nursing practice.
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Nurses should be respectful, and work effectively cross culturally. Nurses must appreciate cross-cultural populations; understand social structural factors that shape health behaviors; understand the dynamics and challenges of bicultural/lingualism; confront their own ethnocentrism and racism; begin implementing and evaluating service provided to cross cultural populations.
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Integrate basic concepts of human values that are essential for ethical decision-making.
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Altruism: nurse gives full attention to ct. equality: care based on individuals needs irrespective of personal characteristics. Esthetics: express ideas about improvement of health care, adapt to environment to please ct, present self with positive image. Freedom: honor individuals right to refuse tx, support right of providers, encourage open discussion of issues. Justice: act as advocate for health care, allocate resources fairly, report incompetence, unethical things, and illegal practices. Human dignity: safeguard individuals right to privacy, maintain confidentiality, and treat with respect regardless of bkground. Truth: document care accurately and honestly, obtain sufficient data to make sound judgments, participate in professional efforts to protect public from misinformation.
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Analyze selected ethical theories and principles as a basis for ethical decision-making.
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With Utilitarianism one attempts to make decisions that lead to the greatest ratio of benefit to harm for all persons. Ex. Redistribution of Medicare funding to more eligible individuals will have greater likelihood of benefit to quality of life. In Deontology individuals act out of principles that compel them to do what is right. Ex a deontological approach would be at work if a decision to resuscitate and provide despite ability to pay for care and availability of beds.
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Analyze the relationship between ethics and morality in relation to the nursing practice.
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A nurse must be able to deal with human dimensions and search for what is good and right for accurate and efficient care. Ask “how should” questions. A nurse should find the right balance between science and morality. That is, know both what to do for your patients AND who your patients are. A nurse should recognize own values and learn to consider and respect the values of others.
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Use an ethical decision-making framework for resolving ethical problems in health care.
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Situation assessment procedure: find out technical and scientific facts and human dimension of situation (attitudes, emotions, opinions); Identify and analyze available alternative for action (list all possible actions for situation so you fully consider all possible actions that will take place); select one alternative (reconsider situation using skillful decision making, reflect on ethical theory to mesh principles with each alternative); justify the selection with rational discourse on with decision was reached (be prepared to communicate thoughts using reasoning process.
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Outline factors that can influence the communication process
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It involves interpretation, filtration, feedback. There must be a sender, receiver and message. In the dynamic process of communication, with a response (feedback) the receiver becomes the sender and the message changes. Method of delivery influences comm.. And it’s affected by environ. And mind of communicators (the receivers interpretation of the message).
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Things that affect communication interpretation
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Context and env.: situation relevant to communication; describes the whole ambiance, background or particular circumstances that lead to discussion. Precipitating event: event or situation that prompted the communication; Preconceived ideas: conceptions, opinions or thoughts that affect receiver before message has been sent; Style of transmission: open or closed statements, body language, method of organizing message, vocabulary; Past experiences: variety of positive, negative and neutral experiences that have positive, negative, or neutral affect on communication; personal perceptions: affect quality of communication; perception is awareness through senses, and influences all person knows about a situation based on senses.
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Filtration
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Most concise delivery of information; people filter out some part of intended communication that is essential to facilitate understanding.
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Feedback
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Communicants assess both nonverbal and verbal feedback; formed on the basis of interpretation and filtration.
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Apply positive communication techniques in diverse situations
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Openness: self disclose, react honestly, acknowledge and assume responsibility for thoughts and actions; Empathy: experience someone’s p.o.v. without losing own identity; supportiveness: maintain nonjudgmental attitude; positiveness: affirmative regard for self, others, and interactions; equality: each individual is valuable and should be heard.
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Developing trust
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Communicating clearly in correct language; keeping promises; protecting confidentiality; avoiding negative communication; being available to pt.
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Using “I” Messages
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Fundamental component of acceptable communication; “you” makes people defensive.
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Establishing eye contact
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Eye contact avoidance can be interpreted as shy, scared, insecure, preoccupied, unprepared, dishonest, etc. eye contact says “I’m available and you’re important.” It’s important to keep in mind cultural values though.
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Keeping promises
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Honesty and integrity are inherent in keeping promises; once commitment is made, every effort must be expended to fulfill expectation.
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Expressing Empathy
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Understanding experiences of other person is integral to therapeutic relationship; nurse is able to perceive and address needs of patient without emotional involvement.
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Clarifying information
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Both communicating’s clarify anything not understood “what I hear you saying is..” or “I understand you mean…” help communicate to sender what is being perceived.
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Being aware of body language
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Body positioning and movement send loud messages’ effective communication is enriched through open stance or holding one’s arms at side rather than crossed or leaning.
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Touch
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Be sensitive to pt’s personal preference and cultural differences, however, gentle touch can scale mountains in terms of demonstrating genuine interest and concern.
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Recognize negative communication techniques
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Blocking: when response contains noncommittal or generalized answers. Generalizing trivializes concerns when they should be validated. False assurance: “don’t worry” or “it’ll be ok” make pt think nurse is neglectful through trivialization of issue, and patient is not validated. Conflicting messages: when verbal and nonverbal cues conflict; express pleasure at seeing someone but draws back when person extends hand.
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Evaluate conflicting verbal and nonverbal communication cues
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Listening: give undivided attention. Provide feedback, position face to sender, eye contact, note nonverbals, finish listening before you speak. Written communication: misinformation can lead to harm, so be clear with reports and check for errors. Accuracy: paramount in recording legal documentation, be descriptive and nonjudgmental. Attention to detail, written should be quantified whenever possible, create mental image for communication. Thoroughness: completeness of information prevents communication breakdown; anticipating relevant questions before asked. Conciseness: state necessary information as clearly and briefly as possible.
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Respond to inappropriate use of logical fallacies in communication.
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Understanding distortions and fallacies helps nurse recognize difference between legitimate and faulty reasoning, which helps health care providers present issues with proper focus and resolve.
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Ad hominem abusive
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An argument that attacks the person instead of the issue. Speaker hopes to discredit the other person by calling attention to irrelevant fact. “she thinks she’s so smart just because she’s a doctor” influences group to become angry.
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Appeal to common practice
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Occurs when argument is made that something is ok because most people do it.
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Appeal to emotion
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An attempt to manipulate other peoples emotions to avoid the real issue. “I am the first person in my family to even go to college. I’m a single parent, and I’ve worked so hard to get where I am. Our manager doesn’t care about individuals.”
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Appeal to tradition
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The argument that doing things a certain way is best because they have always been done that way. “that’s just how it’s done here” or “that’s the way we’ve always done it.”
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Confusing cause and effect
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Occurs when one assumes that one event must cause another just because we see two events together. “babies born on a night during the full moon are more likely to have birthmarks.” Assumption of cause and effect relationship.
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Hasty generalization
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Involves coming to conclusion based on very small number of examples. Occurs when assumption that a small group represents a whole population is made.
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Red herring
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Introduction of an irrelevant topic to divert attention away from real issue. “it’s not my work that you’re mad about. It’s that I’m a guy, and you don’t like male nurses.” Changes the focus of the argument away from the real issue and on to making other person defensive about her opinions.
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Slippery slope
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Belief that an event will inevitably follow another without any real support for that belief. Often heard as “escalating disaster” logic. “the next thing you know we will be sitting at computer terminals and not taking care of patients”
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Straw man
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Occurs when a person’s position on a topic is misrepresented. “april is so worried about saving money that she wants us to avoid using supplies that would enhance patient care.” Leaves person in a bad light.
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Differentiate between policy can politics
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Health policy is defined as a set course of action undertaken by governments or health care organizations to obtain a desired outcome. It happens at the local, state, and federal level. Politics is the process of influencing the allocation of scarce resources. It mainly involves influencing in the form of campaign contributions, knowledge, relationships, information, talent, and perceived control over large groups of votes.
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Local health policy
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cities or counties may offer health care services to meet residents needs; immuizations at reduced rates or funds to employ RNs at schools, safe drinking water, tobacco-free public areas, seat belt and child restraint laws, emergency medical systems.
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State health policy
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Governs nursing practice thorugh NPA, and has policies that maintain safe meat supply inspections food storage, quality care. Also involves paying for some individual health services like Medicaid which pay for services at specific income level (blend of state and federal), or health care services for prisoners
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Federal Health policy
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Vitally important in health of americans, funding for health and illness research, supplemental funding for education of health professionals, individual health services like Medicaid, medicare, SCHIP, and veteran’s administration. Fed. Health policy shapes nursing pracice: Sheppard-towner act of 1921provided states with matching funds to establish prenatal and child health centers staffed by public health nurses, but was discontinued and AMA persuaded congress that physicians should perform these tasks. Also Hospital Survey and Construction act funded hospital construction and nurse staffing of said hospitals. Today it expands reimbursement for APN and implements policies to address nursing shortage.
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Identify three policy issues of significant consequence to nurses and nursing.
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Renal Dx Program provided funding for dialysis and led to development of new area of nursing practice that’s now nephrology nursing. Medicare part D added prescription drug benefits that required nurses to stay alert to proposed legislation and advocate for better benefits. Medicare program provided funding for health care services for elderly and disabled which led to an increase in hospitalized elderly and increased need for nurses in acute care settings.
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Demonstrate knowledge needed to be a responsible and informed politically active nurse.
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Policy process and nursing process are similar, because they involve: assessment (collecting information), diagnosis (ID of the issue), Plan (development of scope for action), Implementation (action taken to put plan in place), and evaluation (evidence that determines success). Nurses should get involved at grassroots level by registering to vote, joining professional nursing organizations, working in political candidates campaigns, visiting with policymakers or staff members, attending town hall meetings, and communicating with policymakers.
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Use diverse technologic resources to obtain information about current health policy developments and political issues.
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Issues: access to care, prescription drug coverage for Medicare beneficiaries, patient safety and health care quality. Information on these resources can be found at ANA: nursingworld.com, CMS: federal agency responsible for Medicare program cms.hhs.gov, DHHS: federal agency for protecting health of Americans and providing essential human services, IOM: part of national academy of sciences which improves health using scientific knowledge iom.edu, LG: large, voluntary consortium of health care purchasers whose goal is to recognize and reward gains in pt care Thomas.gov, UAN: labor union for nurses nursingworld.org
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Discuss the roles of legislative, administrative, and judicial levels of government.
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Executive: president and executive departments; recommend legislation and promote major policy initiative, implement laws and manage programs, writes regulations, has power to veto. Legislation and accompanying rules and regulations carry weight of law. Legislative: senate and house; possess the sole federal power to enact legislation and able to originate and promote major policy initiatives, but have power to override presidential veto. Administrative decisions made by various governmental agencies. Judicial is Supreme Court and federal district courts; interpret constitution and laws and may effect policy, but are unable to recommend or promote legislative initiatives. Judicial decisions interpret the law.
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