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66 Cards in this Set

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Differentiating Nursing Practice
This model maximizes scarce nursing resources and increases career satisfaction among nurses.
Discuss factors influencing the creation of new models of nursing care delivery
Changes in patients and providers, medical advances, info technology, changes to reimbursement.
Goals of new model: patient’s wants and needs, span sites, demonstrate measurable improvement in patient satisfaction. Quality outcome over time.
Case Management Practice Model
The case management practice model, while focusing on patient care just as extensively as the magnet model, it also places a large amount of attention on reducing costs. This model of care increases patient, nurse and physician satisfaction, improves quality of care, and reduces length of stays, thereby reducing costs.
Magnet Practice Model
Within this model, hospitals are characterized by nurses as being good places to work and are recognized for administering exceptional patient care, and for providing good nursing environments.
-Magnet hospitals have slightly higher RN to patient ratios and a richer skill mix than other hospitals. They also exhibit higher rates of patient satisfaction, lower rates of burnout and a safer work environment.
Patient - Focused Care Model
This model appropriately groups similar patient populations together, simplifies processes, brining services closer to the patients, and broadening staff skills by cross training care providers.
Advantages & Disadvantages of Patient - Focused Care Model
One criticism was an increase in job dissatisfaction among RN’s, LPN’s and Techs, a decreased feeling of collaboration by physicians and managers, and an increased feeling by LPN’s and techs that they had less discretion in their work. An advantage is there is a reduction in medication errors using this plan due to the increase in technology.
Primary Nursing Model
Primary nursing focuses of continuity of care beginning with the admission and ending with discharge. A primary nurse is responsible for the same patient’s care throughout the patients stay.
Advantages & Disadvantages of Primary Nursing Model
One criticism is that this model is not cost effective or efficient because RN’s are required to perform both direct and indirect care activities. The advantage of this model is that patient stress was decreased because the nurse/ patient relationship had more time to form and progress.
Team nursing model
Team nursing is based collaboration and division of responsibilities for the nursing care of patients. In this model, the team leader, usually an RN coordinated activities of the team staff, delegating major tasks, making assignments and rounding with MD’s.
Advantages & Disadvantages of Team nursing model
This model has been criticized of being to task oriented, increasing fragmentation of care, and reducing the amount of direct nursing care provided by the RN. However, team nursing care may conserve costs and human resources when the ratio of caregivers to patients is low, which we have to be honest, doesn‘t happen very often.
Identify factors that can influence nursing care delivery models
-Changes in the nurses roles and the organization of care delivery may impact their style of practice and outcomes of their patients.
-At the heart of this challenge lies the need to maximize both nurse satisfaction with the work environment and effective and efficient care delivery, while also maintaining highest standards for quality of care and patient safety.
-Another obstacle that must be met is the balance between supply and demand, organizational effectiveness, staff satisfaction, and financial feasibility.
The Nursing Delivery Model
is a model that illustrates the framework for professional nursing practice throughout all the industry. The nursing care delivery model explains the process in which a dynamic solution can meet the ever-changing needs of the patients and their families. The nursing care delivery model combines the values of human dignity of the nursing practice, evidence-based practice, and group collaboration to promote a more full-filling environment for professional growth and development of nurses with lasting outcomes in the quality of patient care.
Discuss the implications of licensure in a compact state
Compact states- a RN receives a license it is either in a compact or non-compact state, a compact stat allows the nurse to practice under his/her current license in multiple states. A non-compact allows the nurse to practice only in the state the license was granted. There are 24 states involved in the nurse licensure compact.
Describe the role/function of licensure and of certification
a. Licensure-
1. Regulated by the state boards or nursing, legal permission to practice, and protects the public.
b. Certification-
1. Voluntary, not regulated by individual states, board certification and recognition empowers nurse within their professional sphere of activity and contributes to better patient outcomes, and a measurable means to validate nurse’s skills, knowledge, and abilities.
Identify warning signs of impending violence and appropriate actions to diffuse/de-escalate someone becoming violent.
a. small incidents- change in voice, loud talking or chanting, shallow or rapid breathing, scowling or sneering or use of abusive language, glaring or avoiding eye contact, or violating your personal space.
b. other signs- HX of violence, threatening behavior, intimidating behavior, increase in personal space, negative personality characteristics, changes in mood or behavior, social isolation, and the use of drugs and alcohol.
Identify risk factors for violence
a. family member or patient against the nurse- This type can be very brutal and violent, any of the three forms of violence.
b. coworker against the nurse- homicide the most severe form of violence, is the second leading cause of death in the work place. Can be any of the 3 types of violence though.
c. student nurse- horizontal violence is a term use to depict abusive behavior between coworker of similar status such as staff nurses in the workplace
Discuss types of workplace violence
a. Non-physical- intimidation, abuse, threats, harassment, and bullying. Report any incident to attempt to reduce the risk of precipitating violence.
b. Physical- punching, kicking, biting, pushing, the assault should be reported immediately with the perpetrator being removed by the police or security guard.
c. Aggravated physical- weapons included but not limited to: guns, knives, syringes, furniture, bottles, glasses, etc. should never be tolerated require immediate action and removal of perpetrator by police or security guard.
Identify components of SBAR’
a. Situation
b. Background
c. Assessment
d. Recommendation
Discuss components of problem-solving/team building
Problem solving and the nursing process is comparable, the steps for this are
a. Define the problem
b. Identify the solution
c. Select and implement solutions
d. Evaluate outcome
Discuss communication strategies to improve communication
Use assertive communication: therapeutic communication, active listening, and have the willingness to compromise. Communication must be clear, miscommunication is a threat to patient safety, your actions impact everyone, you are in control of your behavior, and your response to a situation must be guided by critical thinking, assertive communication, active listening, and the ability to move on.
Identify factors affecting communication
a. Image
b. Gender Differences
c. Cultural diversity
Identify types of diversity
religion, ethnicity, language proficiency and reading comprehension, gender, age, education level, mobility, economic status.
Culture is defined as the customary beliefs, social forms, and material traits of a racial, religious, or social group.
Discuss changes in US in terms of population diversity
America is a melting pot - our culture is extremely diverse and growing. U.S. Census: minorities make up 35% of the US population; by 2050, about half the U.S. population will be made up of people who are of a race other than white. AMA nation wide study (2005): 87% of physician’s who participated in the study reported having cared for a patient within the past month who did not speak English fluently. Nearly 2/3 of the nation’s physicians (62%) report they have witnesses a patient receive poor quality health care because of the patient’s race or ethnicity.
Identify nursing strategies to deal with culturally diverse patients
become a culturally competent nurse:a nurse that has the enhanced ability to provide quality care, which fosters a better understanding of the plan of care.In a global society that is becoming extremely diverse, cultural competence is necessary for excellence in nursing care. Nurse must be culturally competent in order to provide quality care to patients. We must be culturally competent and we must take active steps to become so. Implement cultural diversity training and research to determine impact of cultural competency training for staff. Use internal and external resources to educate staff on different culture and religions. Expand the joint commission national patient safety goal #1310 to address diversity. Standardize the process of collecting and analyzing data from culturally diverse patients. Regulate the usage and implementation of diverse data in hospitals. Appropriate categorization of race, ethnicity, and language data. Employ multi-lingual health care interpreters, establish written guidelines regarding the usage of language services. Disallow the use of family members for interpreting during medical encounters. Require training on the practice of health care interpreting for all interpreters. Provide financial incentives to attract and retain qualified health care interpreters.
Identify the hx of collective bargaining and why nurses participate in collective bargaining
In the early 1940’s, most nurses working in hospitals were subject to arbitrary schedules, uncompromised overtime, no health or pension benefits, and no sick days or personal time. During this era, 75% of all hospital-employed nurses worked 50-60 hours a week meeting these arbitrary schedules and uncompensated overtime. In 1946 the ANA house of delegates unanimously approved a resolution that formally initiated the journey of RN’s down the road of collective bargaining. Activist nurses within the ANA founded the United American Nurse in 1999. (seen in #2). In 2000 the UAN held its first National Labor Assembly annual meeting. The participants in this meeting were staff delegates. Many formally organized unions have competed for the right to represent nurses. It was the opinion of nurses supporting this precedent that the state nurses associations were the proper and legal bargaining agents and were also the preferred representatives for nurses in this country for purposes of collective bargaining. During the late 1980’s, the demand among nurses for representation continued to grow; yet efforts to organize nurses for collective bargaining were being stymied by a decision from the National Labor Relations Board (NLRB) that stopped approving all-RN bargaining units. A legal battle then ensued with the ANA and other labor unions against the American Hospital Association (AHA). The NLRB issued a ruling that reaffirmed the right of nurses to be represented in all-RN bargaining units.
Identify organizations/groups identified in collective bargaining
United American Nurse - The traditional collective bargaining unit affiliated with the American Nurses Association and a member of the AFL-CIO. Believed in the creation of a powerful, national, independent, and unified voice for union nurses.
Center for American Nurses: An organizational member of the American Nurses Association that represents the interests of nurses who are not formally represented by a collective bargaining unit or union.
Differentiate between types of collective bargaining
Traditional Collective bargaining - a legally regulated collective bargaining unit or a union that assists members to gain control over practice, economics in the health care industry, and other health care issues that threaten the quality of patient care.
Nontraditional Collective bargaining - shared governance, or interest-based bargaining (IBB); a collaborative-based, problem-solving approach to assist nurses to have a voice in the workplace and control over issues that affect their practice.
What are the roles of nurses in managed care?
•Clinical Nurse Specialist
•Nurse Practitioners
•Certified Nurse Midwife
•CRNA
•Nurse Educators
Describe medication administration safety issues
•Medication Administration Records (MAR) not consistently used or referenced when administering medication.
•Dose omissions or extra doses when staff share medication administration responsibilities.
•Nonstandard medication times resulting in dose omissions.
•Unfamiliarity with lab values and vital signs that should be monitored prior to administering medications.
•Preparing drugs for multiple patients can lead to giving medications to the wrong patient.
•Lack of information about the drug.
•Use of nonstandard, flawed, or unsafe medication delivery devices.
•Unsafe storage and distribution of drugs.
•Failure to work as a team and communicate.
•miscommunication of drug orders, which can involve poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations.
Identify issues/trends related to Hospital Acquired Infections and strategies to combat HAI’s
HAI’S: Are commonly transmitted when hospital officials become complacent and personnel do not practice correct hygiene regularly. Hand washing frequently is called the single most important measure to reduce the risks of transmitting skin microorganisms. Although hand washing may seem like a simple process, it is often performed incorrectly
Discuss requirements in BSN education
Aquinas Requirements for RN-BSN:
a.Graduate of an NLNAC credited diploma or Associates of Nursing Program
b.2.5 GPA
c.2 letters of recommendation from two medical professionals with a BSN degree or higher level of education. (See, with your BSN you can write letters of recommendations for students who want to go to Aquinas!)
d.General education courses should be completed prior to RN-BSN program
Describe the role of certification
•The benefits of specialty certification reach throughout the healthcare system—from nurses, the nursing profession, and employers to hospitals, patients, and families.
•Certification validates nurses’ knowledge and skills, improves quality and safety, and gives patients a benchmark to measure the level of care they can expect to receive at a healthcare facility.
Discuss the history of evidence based practice in nursing
•Evidence Based Practice first came about with the “Legend Lady”, Florence Nightingale.
•She changed the way patients were taken care of by noting a connection between poor sanitary conditions among hospitals and the rising death rates of wounded soldiers.
•The first time Evidence Based Practice initially gained recognition was in 1992 when the journal of The American Medical Association published an article by Evidence Based Medicine Working Group.
Identify factors influencing utilization of EBP by new graduates
The challenges that new graduates experience on entering clinical practice have been well documented in nursing literature. Although new graduates and their employers are forewarned about the difficult transition, the challenges continue, and may be even more difficult as the health care system embraces evidence-based practice (EBP).
The transition to graduate nurse responsibilities is a challenging one for new nurses. Because new nurses focus on the task and organizational demands of the workplace , their abilities to practice EBP is compromised by their anxiety, and limited experiential knowledge .
Describe licensure
Licensure affords protection to the public by requiring an individual to demonstrate minimum competency by examination before practicing certain trades. Nursing licensure is a process by which a governmental agency grants “legal” permission to an individual to practice nursing. This accountability is maintained through state boards of nursing, which are responsible for the licensing and registration process. All Grads must successfully complete the NCLEX-RN.
Describe certification
certification is defined as a “voluntary process by which a nongovernmental agency or association certifies that an individual licensed to practice a profession has certain predetermined standards specified by that profession for specialty practice”. The nursing license is recognized as indicating minimum competency, whereas the certification credential indicates preparation beyond the minimum level. Certification is the credential that provides recognition of professional achievement in a defined functional or clinical area of nursing practice
What is burnout and what are strategies to prevent/decrease burnout?
Burnout-Issues in nursing that cause new nurses to leave p only a few yrs. The increase in patient acuity, coupled with shortened hospital stays, is not compatible with the emphasis on high-quality, safe patient care and consumer satisfaction. These opposing philosophies create conflict for nurses and lead to burnout that is not as easily remedied as burnout caused by internal factors. Therefore, it is important to recognize clearly the mission of the hospital or corporation when you apply for your first job. Is their mission similar to yours? Will you be able to give the quality care that you want to deliver, or will you be required to compromise your values to fit into the system?
Nurses need to determine whether their burnout is caused by internal or external factors. A nurse who neglects his or her own needs can develop feelings of low self-esteem and resentment. These feeling could affect the care you provide to others, Therefore, by taking care of yourself, you are ultimately able to provide better care for others.
Describe key changes in nursing during historical periods discussed in class
Nurse= Nourishing
Early Christian Influence- Deacons, Deaconesses, Nuns
Women sympathetic to the Christian cause of aiding the poor were encouraged in this work by the bishops and deacons. Eventually, the deacons relinquished this work to women and established the position of deaconess for that purpose. To maintain a pure heart, these women were required by the Church to be either virgins or widows. Could only be married once. The deaconesses, widows, and virgins continued to minister to and nurse the ill within the safety of the convent.

Knight Influence- Hospital of St. John was built
Often the knights were accompanied into battle by men trained in the healing arts. These male nurses cared for wounded or otherwise stricken knights. They usually wore a red cross emblazoned on their tunics so that in the heat of battle they could be easily identified and avoid injury or death. Male nurses dominated these orders.

Crimean War - More people died from disease than injury from war

American Nursing – Colonial influence – Women were preferred but most of the individuals who delivered nursing care in the five largest hospitals were men.

Civil War – Volunteer Nurses
Improvement in patient care through control of the environment in which the patient recovered.
The greatest problems for the Army stemmed from the poor sanitary conditions in the camps, which bred diseases such as smallpox and dysentery. The results were many deaths from inadequate nutrition, impure water, and a general lack of cleanliness. It was in this era that the value of primary prevention, or the prevention of the occurrence of disease by measures such as immunization and the provision of a pure water supply, became understood.

Victorian Age – Man had total control of the house. Nursing provided an escape. Power of the Doctor, Better education, New legislation, had to be licensed. A time of repression but also a time of reform.
Nurses generally were women who wanted to avoid the drudgery of a Victorian marriage. They were required to be single to make a complete commitment to their vocation. Schooled in submission, women were expected to be equally accommodating within the hospital organization.
Reformers focused on establishing standards for nursing education and practice. Among their accomplishments were the organization of the American Nurses Association and the creation of its journal, the American Journal of Nursing, and the enactment of legislation to require the licensure of prepared nurses. This protected the public from inadequate care given by people who were not trained to nurse
Identify Florence Nightingale’s role and contributions to nursing.
Florence Nightingale - Victorian times - beautiful, intelligent, wealthy, socially successful, and educated.
Nightingale's interest in hospital reform was insatiable. She visited hospitals and took copious notes on nursing care, treatments, and procedures. She sent reports on hospital conditions to Sidney Herbert, the British Secretary of War. Secretary Herbert then assigned her other hospitals to review. The reviews always included recommendations for improving nursing care. Nightingale's great success prompted her to begin developing schools of nursing based on her knowledge of what was effective nursing.
Describe issues related to healthcare access and cost both historically and in the present
overuse of the insurance based payment system. Low labor productivity growth. Constrained supply of healthcare providers. Enough wealth to support the costs. Money to hospitals, Dr’s and technologies. Fragmentation of insurers and providers = Increased administrative costs. Success, creates more costs (more people surviving and need lifetime healthcare = more $ spent on patient)
Recognize characteristics of Managed Care organizations
-Managed care organizations often enroll members who have a specific disease, such as diabetes, in a program tailored for the needs of clients with that condition.
-The program focuses on prevention and educational activities when members are NOT in the acute stage of the disease, so that they will be prepared to understand and manage symptoms throughout their lives.
-Nurses, often employed by health plans, are frequently involved in this component of disease management.
-Disease-Management protocols also outline standard interventions to be implemented during the acute stage of the illness, although physicians or other providers may make modifications to provide individualized care.
-Disease-management programs are primarily for clients with chronic diseases that occur frequently, those that vary widely in treatment options, and those that are very expensive to treat.
Describe the time frame required to translate research into practice
In 2000, the Institute of Medicine (IOM) released a report, “Crossing the Quality Chasm: A New Health System for the 21st Century”. This report noted that it takes 17 years for the results of research in health care to be transmitted into consistently used practice. Evidence based practice is one strategy to reduce the amount of time required to integrate new health care findings into practice. EVP is the conscientious use of current best evidence in making decisions about client care. EVP uses the following steps to answer clinical questions: 1. A systematic search for the most relevant evidence to the question. 2. Critical evaluation of the evidence found (Is the evidence logical and valid?) 3. Your own clinical experience (Does your experience fit with the evidence?) 4. Client preferences and values (Will your clients accept the recommendations drawn from the evidence?) The answer to the questions can then be implemented in practice or incorporated into critical pathways and disease-management processes.
Identify appropriate interview behaviors and resume strategies to facilitate obtaining a first nursing position
Resume: be current, concise, and honest. Be open to suggestions recruiters may have. Your resume is the 1st intro a prospective employer has with you. Define your strengths and skills. Avoid using I or me in your resume. Proofread. Don’t inquire about salary or benefits in the resume. Include: Who you are. Professional objective. Education. Professional experience. Licensure. Professional organizations. Honors and awards. References (if asked for).
Interview: Dress the part. Be conservative with hair and makeup. Wear minimal jewelry. Wear hose with a skirt or a dress. Men, consider a suit or jacket with coordinating slacks. Don’t bring kids. Arrive early. Ask how long it might take (prior to). Identify and control your nervous habits. Consider a portfolio (examples of work you have done; papers, etc.). Sell yourself, but let the institution sell themselves too. Ask questions (prepare before hand). Use buzz words; critical thinking, communication, problem solving. Salary and benefits are usually discussed after a position has been offered. You may even need to get the info about that from the HR department. Interviews have 3 phases. 1. introduction. 2. Fact finding (your resume and you do most of the talking). 3. Closing (summary and your questions).
Identify the components of the Healing Relationship Model central to understanding ethics in the practice of nursing
Healing relationship model: A dynamic interaction developed over time between 2 persons: one person, vulnerable, exploitable, suffering and seeking help; one person, who offers to help and to heal, to restore health, and when this is not possible, restoration to wholeness.
Describe the role of authenticity in Nurse-Patient Relationships
Promise made to one who is sick, in need, and vulnerable. Relationship is one of inequality where the clinician holds the balance of power. Inequality of power possesses special obligations on the clinician who professes to help. An active, conscious declaration, voluntarily entered into that signifies willingness to assume the obligation to make this promise authentic. Implicitly occurs during every clinical encounter during which the clinician promises to help. The promise to help and to heal is always above that of the clinician. The promise must be true and authentic and built on a covenant of trust-not a contract.
Describe the activities of the Tiger Initiative and its competencies for practicing nurses
Technology Informatics Guiding Information Reform - Who are informatics experts? Invited these people to address the issue of electronic health records. How to engage nurses? Hot to implement the plan of action? What capabilities are needed? How to come up with programs, systems and applications to meet this goal? Tiger initiative outlined competencies for nurses. These are: computer skills, information literacy, and information management.
Describe the development of nursing informatics
first recognized by ANA in 1994. ANA defined informatics as a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice.
-NI facilitates the integration of data, info, and knowledge to support clients, nurses, and other providers in their decision making in all roles and settings. This support is accomplished through the use of information structures, info processes, and info technology.
-The extensive clinical background of the NI is invaluable to the success of the implementation of these outline, computer applications.
-Nurses have a unique understanding of workflow, the hospital and clinical environments, and specific procedures that are necessary for effective health info infrastructure.
-Moreover, the NI is critical to the translation of standard info into practical models that can be applied to improve the health care work environment.
Identify examples of regulation influencing informatics
NI must have clear understanding of regulations to guide organizations within boundaries.
HIPPA - ensures that health care organizations collect right data in common format. Standards signed into law that protect the privacy and security of client data. Ex. Health information privacy law, Data security law, and Electronic transaction standards. (privacy laws)
The Joint Commission - inspects and reviews variety of areas within each organization. Implemented information management standards in the mid 1990’s (total of 10). Ensures that facilities are meeting high performance standards through certification. Need for information management regulation.
Identify issues in evaluating material from internet web sites
Remember CAFÉ - Challenge information and demand accountability. Adapt and require more credibility and evidence for stronger claims - be skeptical of info. File new information in you mind rather than immediately believing or disbelieving. Evaluate and reevaluate regularly - recognize dynamic and fluid nature of information.
Remember CARS - Credibility - authoritative source? Accuracy - correct today? Reasonableness - engages subject thoughtfully, reasonably, truthfully? Support - triangulated sources?
Identify record/information systems being developed in health care settings
Clinical Info Systems - CIS’s have replaced paper and pencil charting. Development and application of CIS’s are essential for health care to leverage state of the art technology to deliver highest quality, lowest cost care.

EHR - electronic health record. A longitudinal electronic record of patient health information generalized by one or more encounters in any care delivery setting. Includes patient demographics, process notes, problems, meds, VS, past hx, immunizations, lab data, and radiology reports. The EHR automates and streamlines the clinician’s workflow. it can generate a complete record of a clinical patient encounter, as well as support other care related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcome reporting. Benefits - interactive to all components of care, interactive flow sheets, tailored order sets, and multiple components of care can be integrated.

PHR - Patient health record - an electronic record of health related info on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared and controlled by the individual.

EMR - electronic medical record - an electronic patient care record created by an agency or agencies having common ownership. Although these are often called EHR’s, they are not true EHR’s because the data is nor shared between providers in agencies under different ownership.

email - few Dr’s use this. Could eliminate phone tag. Drug-refill requests and educational info could be accessed. Never use personal email as a nurse or Dr.

PDA - allows bedside collection and charting. Conserves time and reduces steps to and from nurses station. Offers easier information transmission between workers. Portability and info at your fingertips. Can use to monitor: BG, BP, diet, activity. Can: calculate dosages, analyze lab results, access reference materials, check for drug interactions, schedule procedures, order meds, “beam” assignments.
Define the term transitions as it is used in nursing role transitions
Define the term transitions as it is used in nursing role transitions? Transitions are passages or changes from one situation, condition, or state to another that occur over time. They have been classified into the following four major types: developmental (e.g., becoming a parent, midlife crisis), situational (e.g., graduating from a nursing program, career change, divorce), health/illness (e.g., dealing with a chronic illness), and organizational (e.g., change in leadership, new staffing patterns)
Identify your role in transitions
Some of the most important decisions you will make in your professional life are the decisions and choices you make about how you think about and deal w/ transitions. Your thoughts, expectations, attitude and actions will influence your transition experiences. Think post, be flexible, get organized, stay healthy
Define the Stages of Reality Shock(Kramer) and Novice to Expert Model(Benner)
Reality Shock is a term often used to describe the reaction experienced when one moves into the work force p several yrs of educational preparation.
Phases dev in 1974 – Honeymoon phase - The recent graduate is thrilled with completing school and accepting a first job. During this exciting phase, your perception of the situation may feel unreal and distorted, and you may not be able to understand the overall picture.
Shock and rejection - Has excessive mistrust, Experiences decrease in energy and feels excessive fatigue, Feels like a failure and blames self for every mistake, Bands together and depends on people who hold the same values, Experiences increased concern over minor pains and illness
Recover- Beginning to have sense of humor, decrease in tension, Increase in ability to be objective
Identify examples of the four different types of transitions discussed in class.
Developmental - becoming a parent
Situational - coming to nursing school, career changes, divorce
Health/ illness - new disease, diet changes, medication needs.
Organizational - changes in leadership, staffing organization, medical reimbursement.
Discuss safety issues and impact of role transition issues identified by the NCSBN
The problem - complex health care needs, practice readiness, expertise gap, variable transition experiences, risk for practice errors, turnover/ retention.

The impact - med errors, newly licensed nurse errors, life threatening complication recognition, patient safety, error reduction and better outcomes r/t transition programs, cost savings.
Identify strategies to assist the nurse in role transition
Recognize the importance of attitude, Surround yourself w/ supportive people, Set realistic expectations, Find Mentors
Describe the NCSBN proposal for Transition into Practice Models
Transition to Practice Regulatory Model is intended to be collaboratively implemented w/ education and practice but through regulation.
Models included - preceptor model
Time period – 6months
Five Transitions Modules-
Communication and teamwork
Pt centered care
Evidence based practice
Quality improvement
Informatics
Identify the process of development of the NCLEX –RN exam
Licensure to practice is regulated by licensing authorities w/in each state
To ensure public protection states require candidates for licensure to pass exam to measure competencies need for entry level practice
The NCSBN develops the licensure exam
Questions are based on defined test plan
The test plan is a blueprint for entry level practice
Test plan researched q 3 yrs
According to the NCSBN, the NCLEX is designed to test “knowledge, skills and abilities essential to the safe and effective practice of nursing at the entry level”
Analysis guides development of framework for entry level practice that incorporates specific client needs and processes fundamental to practice of nursing
The examination is constructed from questions that are designed to test the candidate's ability to apply the nursing process and to determine appropriate nursing responses and interventions to provide safe nursing care. The distribution of content is based on the areas of client needs, and the nursing process is integrated throughout. There are four levels of client needs identified in the Job Analysis Study
Identify test item formats used in the NCLEX-RN exam?
Administered by Computerized Adaptive Testing (CAT) – uses computer tech and measurement theory
Maximum test time is 6hrs
Answer between 75-265 questions
Instructions and breaks included in the time
Test items go through extensive review process

Types of test items
Multiple choice
Multiple response
Fill in blank
Drop and Drag
Hot spots

Prepare 6months b4 test
Practice NCLEX questions
Start using review books now!!!
what is major goal of Nursing infromatics
EHR major goal of NI.
Describe key changes in nursing during historical periods discussed in class:
Early Christian Influence
Deacons, Deaconesses, Nuns
Women sympathetic to the Christian cause of aiding the poor were encouraged in this work by the bishops and deacons. Eventually, the deacons relinquished this work to women and established the position of deaconess for that purpose. To maintain a pure heart, these women were required by the Church to be either virgins or widows. Could only be married once. The deaconesses, widows, and virgins continued to minister to and nurse the ill within the safety of the convent.
Describe key changes in nursing during historical periods discussed in class:
Knight Influence
Hospital of St. John was built
Often the knights were accompanied into battle by men trained in the healing arts. These male nurses cared for wounded or otherwise stricken knights. They usually wore a red cross emblazoned on their tunics so that in the heat of battle they could be easily identified and avoid injury or death. Male nurses dominated these orders.
Describe key changes in nursing during historical periods discussed in class:
Crimean War
More people died from disease than injury from war
Describe key changes in nursing during historical periods discussed in class:
American Nursing – Colonial influence
Women were preferred but most of the individuals who delivered nursing care in the five largest hospitals were men
Describe key changes in nursing during historical periods discussed in class:
Civil War
Volunteer Nurses
Improvement in patient care through control of the environment in which the patient recovered.
The greatest problems for the Army stemmed from the poor sanitary conditions in the camps, which bred diseases such as smallpox and dysentery. The results were many deaths from inadequate nutrition, impure water, and a general lack of cleanliness. It was in this era that the value of primary prevention, or the prevention of the occurrence of disease by measures such as immunization and the provision of a pure water supply, became understood.
Describe key changes in nursing during historical periods discussed in class:
Victorian Age
Man had total control of the house. Nursing provided an escape. Power of the Doctor, Better education, New legislation, had to be licensed. A time of repression but also a time of reform.
Nurses generally were women who wanted to avoid the drudgery of a Victorian marriage. They were required to be single to make a complete commitment to their vocation. Schooled in submission, women were expected to be equally accommodating within the hospital organization.
Reformers focused on establishing standards for nursing education and practice. Among their accomplishments were the organization of the American Nurses Association and the creation of its journal, the American Journal of Nursing, and the enactment of legislation to require the licensure of prepared nurses. This protected the public from inadequate care given by people who were not trained to nurse