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Nursing

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The protection and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, and families

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Florence Nightingale saw the role of nursing as having

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\"Charge of somebody's health\" based on the knowledge of \"how to impact the body in such a state to be free from disease or to recover from disease\"

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Clara Barton was founder of

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The American Red Cross

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Mary Mahoney was the first professionally trained

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African american nurse

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Isabel Hampton Robb initially founded

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The Nurses' Associated Alumnae, which later became ANA

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Lillian Wald and Mary Brewster

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Opened the Henry Street Settlement, focusing on the health needs of the poor.

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External forces that have affected nursing practice in the 21st century is

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Health care reform, demographic changes, medically under served, threat of bio terrorism.

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A challenge to our nursing practice today is

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Rising health care cost

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A profession has the following primary Characteristics

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- Requires a basic liberal foundation and an extended education of members - It has a theoretical body of knowledge leading to defined skills, abilities, and norms. - Members of a profession have autonomy in decision making and practice. - The profession as a whole has a code of ethics for practice.

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ANA standard of nursing practice

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- Assessment - Diagnosis - Outcomes identification - Planning - Implementation - Evaluation

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ANA standards of professional performance

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- Ethics - Education - Evidence based practice and research - Quality of pracrice - Communication - Leadership - collaboration - Professional practice evaluation - Resources - Environmental Health

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Code of ethics is

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The philosophical ideals of right and wrong that define the principles you will use to provide care to your pt.

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Associate Degree

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A 2 year program focusing on basic sciences and theoretical and clinical causes

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Baccalaureate Degree

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A 4 year program that includes social sciences, arts, and humanities.

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Masters Degree

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Emphasizes research-based clinical practice

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Doctor of Philosophy

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Emphasizes basic research and theory

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Doctor of Nursing Practice

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A practice-focused doctorate

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In Service Education

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Instruction or training provided by agencies

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Continuing Education

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Formal, organized educational programs offered by various institutions

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Nursing Practice Acts (NPA)

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Regulate the scope of nursing practice and protect public health, safety, and welfare

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Benner 5 Level Of Proficiency

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- Novice- Beginning nursing student - Advanced beginner- Has had some level of experience - Competent- Been in the same clinical position for 2-3 yrs - Proficient- More than 2-3 yrs in the same clinical position - Expert- A nurse with diverse experience

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Autonomy

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Independent nursing interventions that the nurse initiates without medical orders

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Caregiver

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Help the pt maintain and regain health, manage disease and symptoms, attain a maximal level of function and independence.

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Advocate

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Protects pts' human and legal rights and provides assistance in assessing these rights

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Educator

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Explains, demonstrates, reinforces, and evaluates the pt progress in learning.

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Communicator

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Is central to the nurse-pt relationship

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Nursing Administrator

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Manages pt care and the delivery of specific nursing services within a health care agency

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Advanced Practice Registered Nurse ( APRN )

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Four core code: 1. Certified Nurse Mid-wife 2. Certified Nurse Practitioner 3. Clinical Nurse Specialist 4.Certified Register Nurse Anesthetist

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Clinical Nurse Specialist ( CNS)

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Expert clinician in a specialized area of practice

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Certified Nurse Midwife ( CNM )

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Involves the independent care for women in normal pregnancy, labor, and delivery and of newborns.

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Certified Registered Nurse Anesthetist ( CRNA )

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Provide surgical anesthesia

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Nurse Educator

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Works primarily in schools of nursing and staff development

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Nurse Researcher

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Investigates problems to improve nursing care and to expand the scope of nursing practice.

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Manager

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Has personnel, policy, and budgetary responsibility for a specific nursing unit.

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Nurse Practitioner (NP)

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Detects and manages self-limiting acute and chronic stable medical conditions.

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Qsen Competencies

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- Patient centered care - Team work and collaboration - Evidence based practice - Quality improvements - Safety - Inforatics

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Genomics

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The study of all genes in a person and interactions of these genes with one another and with that person's environment.

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Prospective Payment System ( PPS )

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Eliminated cost-based reimbursement

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Capitation

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Providers receive a fixed amount per pt

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Resource Utilization Group ( RUGS )

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Used in long term care

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Managed Care

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Hospitals receive a set dollar amount based on an assigned group

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Diagnosis-related Groups (DRGs)

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Administrative control over primary health care services for a defined pt population.

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Integrated Delivery Networks (IDNs)

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A set of providers and services organized to deliver a continuum of care to a population of pts at a capitated cost in a particular setting.

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Health Promotion

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Reduces the incidence of disease, minimizing complications and thus reducing the need to use more expensive health care resources.

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Preventive Care

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Is more disease oriented and focus on reducing and controlling risk factor for disease through activities such as immunizations and occupational health programs

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Because of _____, more services are available on nursing units thus minimizing the need to transfer pt across multiple areas.

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Work redesign

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_____ is a centralized, coordinated, multidisciplinary process that ensures that the pt has a plan for continuing care after leaving the health care agency,

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Discharge planning

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Instructions pt needs before leaving health care facilities

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- Safe and effective use of medication and medical equipment. - Instruction in potential food-drug interactions and counseling on nutrition and modified diets. - Rehabilitation techniques to support adaption to and/ or functional independence in the environment. - Access to available and appropriate community resources - When and how to maintain further treatment - The pt and family's responsibilities in the pts on going health care needs and the knowledge and skills to carry out those responsibilities. - When to notify their health care provider for change in functioning or new symptoms.

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Restorative Care Goals

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To help individual regain maximal functional status and enhance quality of life through promotion of independence and self-care.

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Examples of home health care services

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- Monitoring vital signs, assessment - Administering parenteral or external nutrition - Medications - Iv or blood therapy - Wound or respiratory care

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Assisted Living

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Long-term care setting with greater resident autonomy

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Respite Care

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Provides short-term relief to the family members who care for the pt.

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Adult Day Care

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Focus of care is palliative, not curative, treatment

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Hospice

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Allows pt to retain more independence by living at home

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Evidence-based Practice

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A problem-solving approach to clinical practice that involves the conscientious use of current best evidence along with clinical expertise and pt preferences and values in making decisions about pt care.

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Pay For Performance Programs

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To promote quality and safe pt care by physicians and health care organizations.

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Picker/Commonwealth Program for Pt Care 8 Dimensions

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1. Respect values, preferences, and expressed needs 2. Coordination and integration of care 3. Information, communication, and education 4. Physical comfort 5. Emotional support and relief of fear and anxiety 6. Involvement of family and friends 7. Transition and continuity 8. Access to care

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Nurse Sensitive Outcomes

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Pt outcomes and select nursing workforce characteristics that are directly related to nursing care.

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Nurse Sensitive Outcomes Example

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The incidence of hospital-acquired pneumonia was highly sensitive to RN staffing levels. Adding just 30 minutes of Rn staffing per pt day greatly reduced the incidence of pneumonia in pts following surgery.

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Nursing Informatics

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Uses information to communicate, manage knowledge, mitigate error and support decision making.

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Rehabilitation Services Begin

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When the pt enters the health care system

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An example of an extended care facility

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A skilled nursing facility

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Community-Base Health

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Focuses on primary rather than institutional or acute care, and provides knowledge about health and health promotion and models of care to the community.

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Public Health Nursing Focus

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Requires understanding the needs of a population or a collection of individuals who have one or more personal or environmental characteristics in common

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Community Health Nursing

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Is nursing practice in the community, with the primary focus on the health care of individuals families, and groups in a community.

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Community-Based Nursing

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Care takes place in community setting such as the home or a clinic where the focus is on the needs of the individual or familiy

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Risk Factors for Immigrant Population

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Hypertension, diabetes, mellitus, and infectious diseases, decreased outcomes of care and shorter life expectations.

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Risk Factors for Abused Pt

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Mental health problems, substance abuse, socioeconomic stressors, and dysfunctional family relationships.

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Risk Factors for poor and homeless

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Chronic health problems tend to worsen because of poor nutrition and the inability to store nutritional foods.

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Risk Factors for substance abusers

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Health and socioeconomic problems.

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Risk Factors for severely mental ill

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Homeless or live in poverty, some can't care for themselves.

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Risk Factors for Older Adults

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more pts and greater demand for health care services.

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Competencies a nurse needs as a caregiver

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Apply the nursing process in a critical thinking approach to ensure appropriate, individualized nursing care for specific pt and their families.

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Competencies as a Case Manager

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The ability to establish an appropriate plan of care based on assessment of pt and families.

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Competencies as a Change Agent

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Identifying and implementing new and more effective approaches to problems.

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Competencies as a pt Advocate

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Provide information necessary for pt to make informed decision, you need to support and at times defend your pt decisions.

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Competencies As A Collaborator

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Competent in working not only with individuals and their families, but also with other related health care disciplines.

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Competencies as a Counselor

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Knowing community resources is a critical factor

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Competencies as an Educator

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Work with single individuals and groups of pts

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Competencies as an Epidemiologist

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Involved in case finding, health teaching, and tracking incident rates of an illness.

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3 Components of a community that needs to be assessed

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1. Structure- name of community or neighborhood 2. Population- age distribution 3. Social system- education system

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Domain

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Prospective of profession

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Paradigm

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Links science, philosophy, and theories accepted and applied by the discipline

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Person

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Is the recipient of nursing care

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Nursing Paradigm includes 4 Linkages

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1. Person 2. Environment 3. Nursing

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Environment

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All possible conditions affecting the pt and the setting of health care.

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Nursing

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The diagnosis and treatment of human responses to actual or potential health problems

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Nursing Theories

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A conceptualization of some aspect of nursing communicated for the purpose of describing, explaining, predicting, or prescribing nursing care.

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Theory

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Concepts, definitions, and assumptions or propositions

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Phenomenon

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Label given to describe an idea about an event or group of situations.

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Concepts

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Ideas and mental image

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Definitions

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Activity necessary to measure the concepts, relationships, or variables

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Assumptions

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\" Taken for granted\" statement

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Middle Range Theories

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Address specific phenomena and reflect practice

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Descriptive theories

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Descriptive, speculate, and describe consequences of phenomena

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Prescriptive Theories

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Action oriented and test the validity and predictability of nursing interventions.

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Interdisciplinary Theory Example

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Piagets theory of cognitive development helps to explain how children think, reason, and perceive the world

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Input

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The data or information that comes from pt assessment

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Output

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Is the end product of a system ( whether the pts health status improves, declines, or remains the same as a result of nursing care)

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Feedback

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Informs a system about how it functions ( the outcomes reflect the pt responses to nursing interventions)

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Content

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The product and information obtained from the system. (the content is the information about the nursing interventions for pts with specific health care)

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Maslow's Hierarchy of Human Needs

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1. Physiological needs 2. Safety and Security needs 3. Love and belonging needs 4. Esteem and self-esteem needs 5.Self-actualization

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M.H. Physiological Needs

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Air, water, and food

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M.H. Safety and Security needs

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Physical and psychological security

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M.H. Love and belonging needs

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Friendship, social relationship, and sexual love

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M.H. Esteem and self-esteem needs

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Esteem needs, self-confidence, usefulness, achievement, and self worth

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M.H. Self-actualization

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The state of fully achieving potential and having the ability to solve problems

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Nightingale's

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The environment was the focus of nursing care

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Peplau's

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Pt relationship

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Henderson's

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Help pt perform 14 basic needs through physiological, psychological, sociocultural, spiritual, and developmental domains,

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Benner and Wrubels

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The goal is to help the pt adapt

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Orem's

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pt self care needs

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Leininger's

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culturally specific nursing care

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Roy's

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Personal concern as an inherent feature of nursing practice

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Watson's

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Philosophy of transpersonal caring

Florida Career College Jacksonville, Florida Fundamentals of nursing Potter – Perry 8th edition

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