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154 Cards in this Set

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According to the 1965 American Nurses Association "First Paper on Education for Nursing", the essential components of professional nursing practice include...

care, cure, and coordination

ANA definition of nursing

Nursingis the protection, promotion, and optimization of health and abilities,prevention of illness and injury, alleviation of suffering through thediagnosis and treatment of human response, and advocacy in the care ofindividuals, families, communities, and populations.

National Council of State Boards of Nursing (NCSBN) guiding principles of nursing regulation?

Protection of the public, competence of all practitioners regulated by the board of nursing, due process and ethical decision making, shared accountability, strategic collaboration, evidenced-based regulation, response to the marketplace and health care environment, globalization of nursing

Historical differences between nurses and medicine

Medicine concerned with diagnosis and treatment (cure) of disease

Nursing is concerned with caring for the person in a variety of health related situations

Cure v. care

How can nursing be conceptualized as both an art and science?

Art: compose of skills that require expertise, adeptness, and proficiency for their competent execution

Science: Requires systematized knowledge derived from observation, critical thinking, study, and research

Characteristics of a profession according to Lucie Kelly, RN, PHD, FAAN

ServicesProvided are vital to humanity and society Useof the Scientific Method to Enlarge the Body of Knowledge Serviceinvolves intellectual activities, accountability EducationWithin Institutions of Higher Education Controlof Professional Policy, Professional Activity, and Autonomy LifetimeCommitment motivated by service and altruism Codeof Ethics to guide decisions and conduct Encouragesand supports high standards of practice

What did the 1997 Woodhull Study on Nursing and the Media find?

Discovered that nurses are virtually invisible in media coverage of health care

How much is employment of RNs projected to grow from 2014 to 2023. Why ?

16%; aging populatiion, increased access to health care

Factors affecting nursing supply

Limited number of spaces in nursing programs, cost of nursing programs, shortage of nursing faculty and clinical placements, retention of current nurses

What position do nurses rank for rates of muscloskeletal injuries resulting in missed work days?

Rank fifth among all occupations

What percentage of needle stick injuries are sustained by nurses?

One half

How did the nursing pin tradition come about? Nursing cap? Nursing uniform?

Pin: maltese cross chosen by Florence Nightingale as symbol for the badge worn by the graduates of her first nursing school. Also used by US Cadet Nurse Corps

Nursing cap: originated in the habit worn by the Sisters of Charity of St. Vincent de Paul

Nursing uniform: originated from the religious and military history of nursing

What are the ANA standards of practice?

Assessment, Diagnosis, Outcomes Identification, Planning, Implementation (Coordination of Care, Health Teaching and Promotion, Consultation, Prescriptive Authority and Treatment), and Evaluation

What is differentiated practice?

The practice of structuring nursing roles on the basis of education, experience, and competence

How does critical care nursing encompass differentiated practice?

Differentiated group professional practice including shared governance model, differentiated care delivery, and shared value

What are the shared governance model, differentiated care delivery, and shared value practices done by critical care nurses?

Shared Governance Model: RNs have a voice and vote in their nurse practice

Differentiated Care Delivery: RN practice is recognized as exampled by Advanced Practice Nurses and Clinical Nurse Specialists

Shared value: recognition of excellence in practices for the bedside RNs in precepting, charge roles, leadership, and collaboration

The Council of Associate Degree Programs gives what 3 roles of nurses?

1. Provider of Care

2. Manager of Care

3. Member within the discipline of nursing

What link did Dr. Linda Aiken find in 2003 about the relationship between nursing education and patient outcomes?

Clear link between higher levels of nursing education and better patient outcomes; surgical patients treated in hospitals with a higher proportion of nurses educated at the BS or higher level have a substantial survival advantage

Clinical ladder systems are often incorporated within...

differentiated nursing practice

Outcomes of differentiated nursing practice

•Increased job satisfaction,decreased staffing costs, decreased nurse turnover rates, decrease in adverseevents, clear nursing roles, and improved patient interventions and outcomes

History of nursing assistants? Where do they provide the majority of care? How do they function?

Began during WWII; provide majority of care in nursing homes; function under direction of RN or LPN

How did the Ombibus Budget Reconciliation Act impact nursing assitants?

•all people working as nursing assistants in nursing homes are requiredto complete a minimum of 75 hours of theory and practice and pass anexamination to be certified.

Nursing Assistant Skills

Changing bed linens.Taking vital signs.Bathing.Personal care.Tube feedingsEnemasAmbulationStable, unchanging clientsFeeding and exercising patients.Safety: safe environment and properuse of side rails, restraints, and patient rights.Home health aide assist individualswith basic care in their home (also grocery, cooking, and laundry)

Training for practical nurses

•Typically takes 1 year to completethe training. •Stress clinical experience instructured care settings (hospitals and long term care).•High schools, trade or technicalschools, hospitals, community colleges.•Graduates take the NCLEX – PN exam

Roles of practical nurse

•Scope of practice focuses on meeting the health care needs of clientsin hospitals, long term care facilities, and the home.•They care for patients whose conditions are stable.•Give direct patient care. •Observe, record and report.•Administer medications and treatments.•Assist in rehabilitation.Directed by an RN or a licensedphysician

Diploma education nursing education

•Earliest type of Nursing Education.•Hospital based post secondary education programs. 27 to 36 months in duration.•Many are affiliated with a college or university so courses are transferable. •Modified apprenticeship model. •Strong emphasis on client experiences.•Nursing management.

What type of nursing education prepares more graduates for licensure as RN's than any other program?

Associate degree education

What is the first and only type of nursing education established on the basis of planned research and experimentation?

Associate degree education

Issues facing associate degree education for nurses

Pressure to increase credits, increased enrollments, selective admission process

Characteristics of baccalaureate education?

•Upper division nursing major that is built onto 2 years of liberal artsand science courses. •Must meet the entrance and graduation requirements of the university. •Basic nursing skills.•Health maintenance and promotion. •Disease prevention.•Supervisory and leadership techniques and practice.•Introduction to research. •Experience in public health nursing, community health setting, andleadership responsibility in acute care.•Emphasis on critical decision making skills, and exercising independentnursing judgments in complex situations.•Collaboration with other members of the health care team.•Supervision of others with less preparation. •Work with groups as well as individuals.

Process of reflective awareness to action

Self-awareness-->self-advocacy-->advocacy for others-->reflective action

What did Hildegard Peplau propose in 1952? What is encompassed?

Interpersonal Relations in Nursing--the therapeutic use of self; involving personality, communication, connectedness, humanistic energy, healing presence, and caring

Stages of the nurse-patient relationship

Pre-interaction, orientation phase, working phase, termination phase

The orientation phase of the nurse-patient relationship involves...

Introduction and assessment; gather information, define the problem, identify strengths; determine client's view of problem and identify strengths in resolution; use basic listening and attending, open ended questions, verbal cues, and leads

What is involved in the working identification phase of the nurse-patient relationship?

Planning and implementation; determine the potential outcomes; discover how the client perceives the resolution and how they can achieve it; use basic listening and attending, giving feedback and influencing and encouraging feedback

What is involved in termination phase of nurse-patient relationship?

Evaluation; generalization and transfer of learning; enable changes in thoughts, feelings, perception, and evaluate effectiveness of the changes the ability to self-care; influencing, feedback, and validating thoughts and feelings

Elements of communication

Context: message, receiver, feedback, and sender

What are operations within the communication process?

Perception, evaluation, transmission

Types of communication with their components

Verbal: spoken speech

Non-verbal: somatic language, action language

Keys to success in nursing

Feedback (affirmation), Appropriateness, efficiency (KISS--keep it simple sweetie principle), Flexibility

What are the revolving thoughts in the nursing process?

Empathy, open-ended questions, giving information, reflection, silence

What is SBAR communication and what is involved?

S=Situation: be prepared with your name, credentials, hospital unit

B=Background: patient, demographics, history

A=Assessment: vitals, O2 stats, pain, pertinent information relevant to patients current status


What are IOM recommendations for interprofessional communication?

Improved communication verbally and in writing between professionals; needs to be accurate and as brief as possible

Key elements in leadership roles

Collaboration, coordination, supervision, delegation

According to the Joint Commission, what % of nurses surveyed reported witnessing disruptive behavior?


Greenlead, 1973 described what aspects of servant leadership?

0Listening0Empathy0Healing0Awareness0Conceptualization0Foresight0Stewardship0Commitment tothe Growth of People0BuildingCommunity

Aspects of teamwork

Communication, coaching, patient satisfaction, servant leadership

Important factors with inter-professional communication

Respect, clarify communication, respond professionally, constructive criticism, support system, documentation, follow up

What is TeamSTEPPS?

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

What is abandonment?

Results when the nurse-patient relationship is terminated without making reasonable arrangements with an appropriate person so that nursing care by others can be continued

Differentiated scope of practice between RN and LPN

Nursing diagnosis not within the scope of LPNs. LPNs in NY do not have assessment privileges, may not interpret patient data independently, may not triage, may not create, initiate, or alter nursing care goals or establish nursing care plans

What is the LPN scope of practice?

Dependent role at direction of RN or other authorized health care providers. Administer meds, provide nursing treatments, gather patient measurements, signs, and symptoms.

Can LPNs practice IV therapy in acute care settings?

Requires RN supervision; RN must document patient's condition (at least every shift) condition relative to IV therapy

Can LPNs practice IV therapy in long term care settings?

Requires RN supervision; RN must document patient's condition (at least every shift) condition relative to IV therapy

What are the legal circumstances in which orders for a patient population with whom an authorized provider has no treatment relationship can be made?

Non-patient specific standing orders for the administration of immunization, anaphylactic agents, purified protein derivative tests, and HIBV tests

What is the mandatory overtime law of 2008?

¢Thisnew law will prohibit health care facilities from requiring nurses to work morethan their regularly scheduled work hours, but does not place a specific cap onthe number of hours that can be worked per day or week. The bill containsexceptions to the mandatory overtime prohibition for the followingsituations:¢Naturalor other types of disasters that increase the need for nursing services, ¢Afederal, state or county declaration of emergency, ¢Anurse engaged in an ongoing medical or surgical procedure, ¢Whennecessary to provide safe patient care where no other alternative staffing isavailable; and Anurse voluntarily agrees to work overtime.

What is the whistleblower protection that was passed in 2002?

protects employees, who provide healthcare services, from retaliatory action by their employers when the employeediscloses or refuses to participate in activities s/he believes constitutesimproper quality of patient care.

What is the professional assistance program? What is it called for nurses?

allows licensees who abuse alcohol orother drugs to surrender their licenses voluntarily and confidentially whileprogressing through an acceptable course of treatment; it is available tolicensees who have not harmed clients. Successful completion of the program mayact as an alternative to disciplinary action

SPAN: Statewide Peer Assistance for Nurses

What is malpractice?

®Malpracticeis negligence applied to the acts of a professional.®Malpracticeoccurs when a professional fails to act as a reasonably prudent professionalwould have acted in similar circumstances.

How is a determination of malpractice made for a nursE?

Nurse's actions will be judged against the nursing standard of care

What is the plan of correction for harm to patients?

1. Correcting the harm to the individual affected

2. Ensuring the same harm is not occurring to others

3. What is the plan to ensure the deficient practice is not going to be done by others?

4. How is the deficient practice going to be monitored in an ongoing manner through quality assurance plan?

reasons documentation is important

Legality, reimbursement, regulatory standards, communicate, quality assurance

What are possible charting formats?

POR: problem oriented record

SOAP: subjective, objective, assessment, plan

PIE: problem, intervention, evaluation

Charting by exception

Focus charting: DAR--data, action, response

What is problem oriented record?

¢Focuson the client’s health problems¢Numericlist of medical problems ¢Nursesrefer to the problem by number and chart observations by referring to thelisted problem by number, name or both

What is charting by exception? When is it best used?

•Basedon policy and procedure for standards of care•Wellsuited for critical pathways•UsesFLOW SHEETS with parameters written and categories pre-defined•Nursescan “check” normal, abnormal, and then deviations from normal have to havefurther clarification via narrative notes or a space on the form

What is involved in focus charting/DAR notes?

Data: Subjective and objective assessment, client behaviors, status and nursing observation to substantiate the strength or weakness (the focus)

Action: Nursing plan and interventions, nursing orders of the focus

Response: evaluation of client's response through client database, flow sheets, graphs, and checklists

Types of medical orders

Written orders, faxed orders, standing orders, verbal orders

What are standing orders? Some typical examples?

¢Providersmay have agency specific guidelines for standard orders that nurses mayadminister medications or treatments or follow certain protocols under certaincircumstancesAdministeringPPDs to new employeesAdministeringFlu Vaccine to all patientsAcetominophenfor temp >101 or complaints of malaise

Process of verbal orders

®TheNurse transcribes the prescribers orders onto an orders sheet (V.O)®Legally,these orders must be signed by the prescribers within a standard time frame

Definition of ethics

}Thebranch of philosophy that concerns the distinction between right and wrong onthe basis of a body of knowledge, not just on the basis of opinions.

Refers to actions an individual would take

Definition of morals

Established rules of conduct; used in situations where decisions about right and wrong must be made; provide standards of behavior that guide actions of an individual or social group

Definition of values

}Attitudes,ideals, beliefs}}Heldand used to guide behavior}}Learnedover time}}Influencedby life experiences and culture}}Freelychosen}}Indicatewhat the individual considers important

Moral reasoning

Psychological interpretative process that helps to connect one's more values with one's ethical choices

Core principles of nursing

vdoing goodvvavoiding harmvvtelling the truthvvkeeping promisesvvtreating persons fairlyvvrespecting privileged datavvself-determination

Moral principles include:

respect for autonomy, nonmaleficence, beneficence, justice

Three conditions of autonomous actions

Intentionality, Understanding, Absence of controlling influences

What is nonmaleficence?

Doing no harm: reasonable consideration of benefit, lack of excessive cost, pain, or other incoveniences

First principle in human interaction

What is involved with beneficence? How can nurses add to this?

Preventing harm, removing harm, doing good, balancing risks, harms, benefits, and effectiveness

Nurses volunteering, using therapeutic communication with a patient

What is justice? Distributive justice?

Fairness, giving to an individual their due (claim or entitlement)

Distribution of benefits and burdens to each person: equal share according to individual need, effort, and societal contribution

What is veracity? What are common issues/conflicts?

Truth-telling: to patients, to third-parties

Not telling "whole" truth, misleading, withholding

What is fidelity?

Faithfulness, keeping promises, honoring commitments

What is Immaneuel Kant's Deontology Theory?

Process oriented, decisions are made based on the nurse's principles and consistent decisions; right or wrongs are determined by the inherent moral significance of the person, not the outcome; acts are moral if they originate from good will

What is Jeremy Bentham and John Stuart Mill's Utilitarian Theory?

Outcome oriented, act utilitarianism or rule utilitarianism, greatest good or least harm for the greatest number, moral rightness is determined only by the consequence

Act utilitarianism v. rule utilitarianism

Act: the end result is obtained no matter what

Rule: The end result/decisions are made based on policy, law, and within context of being fair to the majority of those effected

What is Aristotle, and Alasdair MacIntyre's virtue theory?

Person oriented, addresses moral life and values, based on faith, hope. honesty, charity, and wisdom; moral goodness or badness is addressed in terms of the moral value attributed to the character trait or virtue

Steps in ethical decision making

Clarify, gather additional information, identify options, make a decision, act, evaluate

Types of advanced directives

Health care proxy/agent; living will; MOLST; life sustaining treatment

What is health care proxy?

Legal document that lets you name someone to make decisions about your medical care, including decisions about life support--if you can no longer make decisions and speak for yourself

What is a living will?

Lets you state your wishes about medical care in the event that you develop an irreversible condition that prevents you from making your own medical decisions

What is the MOLST form?

Medical Orders for Life Sustaining Treatment; translates patient/resident goals and preferences into medical orders; is based on communication between the patient/resident or surrogate and health care professionals that ensures informed medical decision making

ANA Code of Ethics: Provision 1-3 involve...

Provisions 4-6 involve...

Provisions 7-9 involve...

Fundamental values and commitments of the nurse; boundaries of duty and loyalty; duties to the broader community

What is tort?

A wrong that is committed bysomeone who is legally obligated to provide a certain amount of carefulness inbehavior to another and that causes injury to that person, who may seekcompensation in a civil suit for dam`ages

Order of how culture is learned

First in family, then school, then in community and other social organizations (such as the church)

Primary characteristics of culture

nationality, race, color, gender, age, religious affiliation

Secondary characteristics of culture

Educational status, socioeconomic status, occupation, military experience, political beliefs, urban v. rural residence, enclave identity, marital status, parental status, physical characteristics, sexual orientation, gender issues, reason for migration, amount of time away from country of origin

What is culture and what is involved?

Culture is a learned, patterned behavioral response acquired over time accepted by a community of individuals

May involve implicit v. explicit beliefs, attitude, values, customs, norms, taboos, arts and life ways

What is multiculturalism?

Diverse cultures coexisting within one world, groups have equal value

What is acculturation?

Incorporating some of the cultural attributes of the larger society by diverse groups, individuals, and peoples

What is assimilation?

Related to acculturation but is more complete adoption of the behaviors, beliefs, norms, and language of the dominant culture

What is subculture?

Social group of people within the dominant culture who have different norms, behaviors, etc. that do not closely follow the dominant culture

What is health disparity?

Differencesin the incidence, prevalence, mortality and burden of disease and other adversehealth conditions that exist among specific population groups in the UnitedStates

What is cultural relativism?

Cultures are neither better nor worse, just different from one another

What is ethnicity?

Social group of people who share common racial. geographic, religious, or historical culture; a conscious choice and awareness of a commitment to cultural identity; social concept, not a biological one

What is ethnocentrism?

Belief that one's own culture is superior, not respecting the culture of others, stereotyping others, a form of discrimation

Positive aspect of ethnocentrism

Responsible for cultural self-survival and helps people maintain self worth and self survival

What is the cultural assessment sequence?

Three step process to determine the meaning of their health seeking and healthcare behaviors: general assessment, problem specific assessment, culture specific details

What is the LEARN style of culturally based teaching?

Listen, explain (what you think the client said), acknowledge (the similarities and differences between both persons and perception), recommend, negotiate (mutually acceptable treatment, intervention, or resolution)

What is a culture of long-term deprivation called?

Culture of poverty

Aspects of Purnell's Model for Cultural Competence. What is the center of the model?

Community, Family, Person, Health

Represents unknown phenomena, practices, and characteristics of the individual and group

What is Madeline Leininger's theory of transcultural nursing?

Aclient who experiences nursing care that fails to be reasonablycongruentwith his/her beliefs, values, and caring lifeways will showsignsof cultural conflict, noncompliance, stress and ethical or moralconcern.

What is Giger and Davidhizar's Model of Transcultural Nursing?

Focuses on assessment and intervention from a transcultural nursing perspective: communication, space, social orientation, time, environmental control, biological variations

How did Rothwell define a group?

A human communication system composed of three or more individuals, interacting for the achievement of some common goal(s) who influence and are influenced by each other

Categories of groups

Primary: spontaneous, informal (ex. family, friend group)

Secondary: planned, time-limited, purpose identified, structured

Specific types of secondary groups

1.Focus2.Therapy3.Activity4.Work groups5.Interdisciplinary health teams, 6.Health Educational groups

Stages/Phases of Group Development

Forming, Storming, Norming, Performing, Adjourning

What is involved in the forming stage of group development?

Inclusion, Orientation (acceptance, anxiety, superficial, development of trust)

What is involved in the storming phase of group development?

Counterdependence, integrating individuals with group goals (power and control issues, behaviors emerge, uncomfortable, control ineffective group behaviors)

What is involved in the norming phase of group development?

Cohesion; standards set (feedback spontaneous, accepted behavioral standards formed, increased accountability, apathy is scrutinized)

What is the performing stage of group development?

Interdependence, sharing and working toward goals--accomplishing work, cohesiveness, affirmation

What is involved in the adjourning phase of group development?

Independence, summarizing--plans for future growth, summation

Non-functional self-roles

Aggressor, blocker, joker, avoider, self-confessor, recognition

Aspects group conflict

Confrontation/collaboration; bargaining; competition; accommodation

Group anxiety includes

scapegoating, acting out, projection/blaming, dependency/withdrawal/passivity, being very critical or very apathetic

Characteristics of effective groups

Leadership style meets the group's aims; power is recognized, utilized appropriately, strong sense of responsibility and accountability, thought out decision making, positive and effective interaction patterns, group cohesiveness, strong group identity

Characteristics of ineffective group

No group identity, lack of group cohesiveness,, poor interaction patterns, lack of decision making, little responisbility and accountability, ineffective leadership styles, power is used and abused and no attention to the powerless

How did the Industrial Revolution affect health care?

Created crowded workplaces that were breeding grounds for disease

Describe how Florence Nightingale influenced the nursing profession in the 1850s.

she organized a school of nursing because she believed nursing education was vital; she developed the profession so it was not seen to contain only subordinate females; she was religious

Why is there still an increase in diploma schools of nursing despite all of the changes in nursing education?

Employers feel as though degree programs are not meeting the needs of nursing staff.

What has led to a smaller applicant pool for nursing students?

Lack of nursing faculty

ANA standards of practice include...

Assessment, outcomes identification, evaluation

Knowledge workers in healthcare acknowledge that change...

inevitable in healthcare

What did Isabel Hampton Robb do as the first president of the American Nurses Association?

Organized the nursing profession at the national level

What does belonging to a professional nursing association do for the nurse?

It allows nurses to be nationally/locally active and improve leadership skills.

What do knowledge workers use while serving as a nurse?

coordination, collaboration, and critical thinking

The nurse practices nondirective listening during which of the following phases of the nurse-client relationship?


Who developed the theory of Social Learning Theory?


What theory did Erik Erikson develop?

Psychosocial development

Peplau described the third stage of self-development as:

Matching of behavior with appraisals

What term best describes a team composed of members from varied disciplines that work together to achieve a common goal?


John, a member of a support group, has noticed that over the past few weeks the group has not been ending on time and that some members have been pairing off to discuss group issues. He brings this up with the group for discussion. This is an example of which maintenance function?

Standard setting

According to the IOM, work in interdisciplinary teams refers to:

Collaboration, Communication, Coordination

Personal values are defined as:

Values taught by one's culture

What process helps the nurse to frame patient problems within the patient’s own cultural context?

Clinical reasoning

ANA standards of professional nursing care

Assessment, diagnosis, outcomes identification, planning, implementation (coordination of care, health teaching, consultation), evaluation

Elements of malpractice

Proximate cause, damages or injury, duty to the patient, duty is breached

Nursing care process

Assessment, Diagnosis, Planning, Implementation, Evaulation-- Constant re-evaluation

Interdisciplinary/inter-professional vs. multidisciplinary

people with distinct disciplinary training working together for a common purpose as they make different, complementary, to patient focused care

a team or collaborative process where members of different disciplines assess or treat patients independently and then share information with each other

Five rights of delegation

Right task, right circumstance, right person, right direction/communication, right supervision

Boards of Nursing

State governmental agencies responsible for the regulation of nursing practice in each respective state

Nurse Practice Acts

Legal documents that communicate professional nursing scope of practice

Peplau's six nursing roles

Stranger role, resource role, teaching role, counseling role, surrogate role, leadership role

CARE acronym

C=connect; A=appreciate; R=respond; E=empower

Functional similiarity

Defined as choosing group members who have enough in common intellectually, emotionally, and experientially to interact with each other in a meaningful way`

Four styles of personal conflict management

Avoidance, accommodation, competition, collaboration